Admission N-terminal pro-brain natriuretic peptide and its interaction with admission troponin T and ST segment resolution for early risk stratification in ST elevation myocardial infarction. Issue 6 (26th October 2005)

• Record Type: Journal Article
• Authors: Björklund, E; Jernberg, T; Johanson, P; Venge, P; Dellborg, M; Wallentin, L; Lindahl, B
• Other Names: group-author.
• Is Part Of: Heart. Volume 92:Issue 6(2006)
• Page Start: 735
• Page End: 740
• Publication Date: 2005-10-26
• Subjects: ASSENT, assessment of the safety and efficacy of a new thrombolytic -- AUC, area under the curve -- BNP, brain natriuretic peptide -- CASS, coronary artery surgery study -- CI, confidence interval -- MI, myocardial infarction -- NT-proBNP, N-terminal pro-brain natriuretic peptide -- OR, odds ratio -- ROC, receiver operating characteristic -- STEMI, ST elevation myocardial infarction -- TnT, troponin T; acute myocardial infarction -- brain natriuretic peptide -- prognosis -- electrocardiography; Heart -- Diseases -- Treatment -- Periodicals; Cardiology -- Periodicals; 616.12
• DOI: 10.1136/hrt.2005.072975
• Languages: English
• ISSNs: 1355-6037

Abstract

Abstract : Objective: To assess the long term prognostic value of N-terminal pro-brain natriuretic peptide (NT-proBNP) on admission and its prognostic interaction with both admission troponin T (TnT) concentrations and resolution of ST segment elevation in fibrinolytic treated ST elevation myocardial infarction (STEMI). Design and setting: Substudy of the ASSENT (assessment of the safety and efficacy of a new thrombolytic) -2 and ASSENT-PLUS trials. Patients: NT-proBNP and TnT concentrations were determined on admission in 782 patients. According to NT-proBNP concentrations, patients were divided into three groups: normal concentration (for patients ⩽ 65 years, ⩽ 184 ng/l and ⩽ 268 ng/l and for those > 65 years, ⩽ 269 ng/l and ⩽ 391 ng/l in men and women, respectively); higher than normal but less than the median concentration (742 ng/l); and above the median concentration. For TnT, a cut off of 0.1 μg/l was used. Of the 782 patients, 456 had ST segment resolution (< 50% or ⩾ 50%) at 60 minutes calculated from ST monitoring. Main outcome measures: All cause one year mortality. Results: One year mortality increased stepwise according to increasing concentrations of NT-proBNP (3.4%, 6.5%, and 23.5%, respectively, p < 0.001). In receiver operating characteristic analysis, NT-proBNP strongly trended to be associated more with mortality than TnT and time to 50% ST resolution (area under the curve 0.81, 95% confidence interval (CI) 0.72 to 0.9, 0.67, 95% CI 0.56 to 0.79, and 0.66, 95% CI 0.56 to 0.77, respectively). In a multivariable analysis adjusted for baseline risk factors and TnT, both raised NT-proBNP and ST resolution < 50% were independently associated with higher one year mortality, whereas raised TnT contributed independently only before information on ST resolution was added to the model. Conclusion: Admission NT-proBNP is a strong independent predictor of mortality and gives, together with 50% ST resolution at 60 minutes, important prognostic information even after adjustment for TnT and baseline characteristics in STEMI.