N-terminal Pro B-type Natriuretic Peptide in the Early Evaluation of Suspected Acute Myocardial Infarction - 25/07/11
, Cathrin Balmelli, MD a, , Tobias Reichlin, MD a, b, Raphael Twerenbold, MD a, Miriam Reiter, MD a, Julia Meissner, MD a, Nora Schaub, MD a, Claudia Stelzig, MSc a, Michael Freese, RN a, Patricia Paniz, MD a, Christophe Meune, MD, PhD a, c, Beatrice Drexler, MD a, Heike Freidank, MD d, Katrin Winkler, MD e, f, Willibald Hochholzer, MD a, g, Christian Mueller, MD, FESC a, b, ⁎ 
Requests for reprints should be addressed to Christian Mueller, MD, Department of Internal Medicine, University Hospital Basel, Petersgraben 4, Basel CH-4031, SwitzerlandAbstract |
Background |
Myocardial ischemia is a strong trigger of N-terminal pro-B-type natriuretic peptide (NT-proBNP) release. As ischemia precedes necrosis in acute myocardial infarction, we hypothesized that NT-proBNP might be useful in the early diagnosis and risk stratification of patients with suspected acute myocardial infarction.
Methods |
In a prospective multicenter study, NT-proBNP was measured at presentation in 658 consecutive patients with acute chest pain. The final diagnosis was adjudicated by 2 independent cardiologists. Patients were followed long term regarding mortality.
Results |
Acute myocardial infarction was the adjudicated final diagnosis in 117 patients (18%). NT-proBNP levels at presentation were significantly higher in acute myocardial infarction as compared with patients with other final diagnoses (median 886 pg/mL vs 135 pg/mL, P <.001). The diagnostic accuracy of NT-proBNP for acute myocardial infarction as quantified by the area under the receiver operating characteristic curve (AUC) was 0.79 (95% confidence interval [CI], 0.75-0.83). When added to cardiac troponin T, NT-proBNP significantly increased the AUC from 0.89 (95% CI, 0.84-0.93) to 0.91 (95% CI, 0.88-0.94; P=.033). Cumulative 24-month mortality rates were 0% in the first, 1.3% in the second, 8.3% in the third, and 23.3% in the fourth quartile of NT-proBNP (P <.001). NT-proBNP (AUC 0.85, 95% CI, 0.81-0.89) predicted all-cause mortality independently of and more accurately than both cardiac troponin T (AUC 0.66, 95% CI, 0.58-0.74; P <.001) and the Thrombolysis in Myocardial Infarction risk score (AUC 0.79, 95% CI, 0.74-0.84; P <.001). Net reclassification improvement (Thrombolysis in Myocardial Infarction vs additionally NT-proBNP) was 0.188 (P <.009), and integrated discrimination improvement was 0.100 (P <.001).
Conclusions |
Use of NT-proBNP improves the early diagnosis and risk stratification of patients with suspected acute myocardial infarction.
El texto completo de este artículo está disponible en PDF.Keywords : Acute chest pain, Early diagnosis, NT-proBNP, Risk stratification
Esquema
| Funding: The study was supported by research grants from the Swiss National Science Foundation (PP00B-102853), the Swiss Heart Foundation, Roche, and the Department of Internal Medicine, University Hospital Basel. |
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| Conflict of Interest: We disclose that Dr. Mueller has received research support from the Swiss National Science Foundation (PP00B-102853), the Swiss Heart Foundation, the Stanley Thomas Johnson Foundation, Abbott, ALERE, Brahms, Nanosphere, Roche, Siemens, and the Department of Internal Medicine, University Hospital Basel, as well as speaker honoraria from Abbott, ALERE, Brahms, Roche, and Siemens. Dr. Reichlin has received research grants from the University of Basel and the Department of Internal Medicine, University Hospital Basel, as well as speaker honoraria from Brahms and Roche. Dr. Meune was supported by a grant from the Freie Akademische Gesellschaft Basel (FAG). All other authors declare that they have no conflict of interest. |
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| Authorship: The authors designed the study, gathered and analyzed the data, vouch for the data and analysis, wrote the paper, and decided to publish. The sponsors had no role in designing or conducting the study and no role in gathering or analyzing the data or writing the manuscript. All authors had access to the data and a role in writing the manuscript. |
Vol 124 - N° 8
P. 731-739 - août 2011 Regresar al número
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