B-type natriuretic peptide blood levels identify patients with non-ST elevation acute coronary syndromes at high risk for complications during intravenous beta-blocker infusion

2011 ◽  
Vol 13 (3) ◽  
pp. 129-135 ◽  
Author(s):  
Nikolaos I Nikolaou ◽  
Michalis J Koutouzis ◽  
Apostolos Christou ◽  
Georgios M Fournarakis ◽  
Sotirios P Patsilinakos ◽  
...  
Keyword(s):  
High Risk ◽  
Natriuretic Peptide ◽  
Beta Blocker ◽  
Acute Coronary Syndromes ◽  
Blood Levels ◽  
Coronary Syndromes ◽  
St Elevation

The value of N-terminal proB-type natriuretic peptide for early identification of myocardial infarction in patients with high-risk non-ST-elevation acute coronary syndromes

2011 ◽  
Vol 49 (8) ◽  
Author(s):  
Robert K. Riezebos ◽  
Gerrit J. Laarman ◽  
Jan G.P. Tijssen ◽  
Freek W.A. Verheugt
Keyword(s):  
Myocardial Infarction ◽  
High Risk ◽  
Natriuretic Peptide ◽  
Acute Coronary Syndromes ◽  
Troponin T ◽  
Diagnostic Odds Ratio ◽  
Operating Characteristics ◽  
Roc Curve Analysis ◽  
Coronary Syndromes ◽  
St Elevation

AbstractN-terminal proB-type natriuretic peptide (NT-proBNP) is a marker of biomechanical strain, secreted by cardiomyocytes in response to ischemia. As necrosis occurs after prolonged ischemia, a rise in NT-proBNP concentration could precede a rise in markers of necrosis.The aim of the study was to evaluate whether NT-proBNP is able to identify those patients with an evolving myocardial infarction (MI) with high-risk non-ST-elevation acute coronary syndromes (NSTE-ACS). Data were analyzed from a prospective cohort of 103 high-risk NSTE-ACS patients admitted within 6 h after onset of pain and treated with an early invasive strategy. NT-proBNP samples, obtained immediately upon admission, were related to the presence of an in hospital MI. The optimal cut-off value for NT-proBNP was determined using receiver-operating characteristics (ROC) curve analysis.Analyses was performed separately for creatinine kinase MB-mass (CKMB) and troponin T (TnT) based MI definitions. In both cases, a NT-proBNP concentration above 40 pmol/L (339 ng/L) at admission proved to be independently associated with the presence of MI. The diagnostic odds ratio (OR) for CKMB-MI was 4.9 (confidence interval 2.0–11.9, p<0.001). The diagnostic OR for TnT-MI was 4.9 (1.8–14.4, p=0.003). Adjusting for differences in baseline variables did not weaken the diagnostic OR. In addition, elevated NT-proBNP concentrations were related to unfavour-able demographic, physical and biochemical parameters.With a dichotomous cut-off value, a single elevated NT-proBNP (>40 pmol/L) at admission provides independent information about the presence of MI in high-risk NSTE-ACS patients.

The prognostic value of N-terminal pro-brain natriuretic peptide in non-ST elevation acute coronary syndromes: a meta-analysis

2012 ◽  
Vol 50 (4) ◽  
Author(s):  
Xiaocong Zeng ◽  
Lang Li ◽  
Qiang Su
Keyword(s):  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Predictive Value ◽  
Acute Coronary Syndromes ◽  
Meta Analysis ◽  
Predictive Values ◽  
Relative Risks ◽  
Increased Risk ◽  
Coronary Syndromes ◽  
St Elevation

AbstractPrecise risk stratification is important in patients with non-ST elevation acute coronary syndromes (NSTE-ACS) on determination for hospitalization and intensity of treatment. A meta-analysis was performed in studies of patients with NSTE-ACS to evaluate the predictive nature of elevated N-terminal pro-brain natriuretic peptide (NT-proBNP).Online searches were conducted using database to identify suitable studies. A summary of relative risks (RRs) for death and myocardial infarction (MI) was calculated using random-effects modeling. We also calculated the pooled sensitivity, specificity, positive predictive value, and negative predictive value.Thirteen studies were included. Elevated NT-proBNP levels were significantly associated with mortality [RR 4.89; 95% confidence interval (CI) 3.85–6.22] and incidence of MI (RR 1.66; 95% CI 1.24–2.22). The sensitivity and specificity for MI was 69.1% (95% CI 66.6%–71.6%) and 43.6% (95% CI 42.9%–44.3%), respectively, along with the positive and negative predictive values for MI of 8.2% (95% CI 7.7%–8.7%) and 95.1% (95% CI 94.6%–95.5%), respectively.Meta-analysis suggests that elevated NT-proBNP levels were associated with an increased risk for MI or death in patients with NSTE-ACS. Normal levels of NT-proBNP are certainly more helpful when selecting NSTE-ACS patients with likelihood for favorable outcomes.

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