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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
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. (UCR)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
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2006 (English)In: Heart, ISSN 1355-6037, E-ISSN 1468-201X, Vol. 92, no 6, 735-740 p.Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
BMJ Publishing Group , 2006. Vol. 92, no 6, 735-740 p.
Keyword [en]
Aged, Female, Humans, Male, Middle Aged, Myocardial Infarction/*blood/mortality, Natriuretic Peptide; Brain/*blood, Patient Admission, Peptide Fragments/*blood, Prognosis, Regression Analysis, Risk Assessment, Sensitivity and Specificity, Survival Analysis, Troponin T/*blood
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-23949DOI: 10.1136/hrt.2005.072975PubMedID: 16251228OAI: oai:DiVA.org:uu-23949DiVA: diva2:51723
Available from: 2007-02-15 Created: 2007-02-15 Last updated: 2013-06-20Bibliographically approved
In thesis
1. Early Risk Stratification, Treatment and Outcome in ST-elevation Myocardial Infarction
Open this publication in new window or tab >>Early Risk Stratification, Treatment and Outcome in ST-elevation Myocardial Infarction
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

We evaluated, in patients with ST-elevation myocardial infarction (STEMI) treated with thrombolytics, admission Troponin T (tnT), ST-segment resolution and admission N-terminal pro-brain natriuretic peptide (NT-proBNP) for early risk stratification as well as time delays and outcome in real life patients according to prehospital or in-hospital thrombolytic treatment. Also, baseline characteristics, treatments and outcome in patients enrolled in the ASSENT-2 trial in Sweden and in patients not enrolled were evaluated.

TnT (n=881) and NT-proBNP (n=782) on admission and ST-resolution at 60 minutes (n=516) in patients from the ASSENT-2 and ASSENT-PLUS trials were analysed. Elevated levels of NT-proBNP and tnT on admission were both independently related to one-year mortality. However, when adding information on ST-resolution (</≥50%) 60 minutes after initiation of thrombolytic treatment, tnT no longer contributed independently to mortality prediction. High and low risk patients were best identified by a combination of NT-proBNP and ST-resolution at 60 minutes.

We investigated consecutive STEMI patients included in the RIKS-HIA registry between 2001 and 2004, if they were ambulance transported and had received prehospital (n=1690) or in-hospital (n=3685) thrombolytic treatment. Prehospital diagnosis and thrombolysis reduced the time to thrombolysis by almost one hour, were associated with better left ventricular function and fewer complications and reduced the adjusted one-year mortality by 30% compared with in-hospital thrombolysis.

Prospective data from the RIKS-HIA registry on STEMI patients treated with thrombolytics were linked to data on trial participants in the ASSENT-2 trial of thrombolytic agents and used for direct comparisons. Patients treated with thrombolytics and not enrolled in a clinical trial at trial hospitals (n=2048) had higher risk characteristics, more early complications and twice as high adjusted one-year mortality compared to those enrolled (n=729). One major reason for the difference in outcome appeared to be the selection of less critically ill patients to the trial.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2005. 70 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 81
Medicine, Acute myocardial infarction, Thrombolysis, Troponin, Electrocardiography, Natriuretic peptide, Prognosis, Prehospital thrombolysis, Treatment delay, Mortality, Registry, Clinical trial, Medicin
National Category
Dermatology and Venereal Diseases
urn:nbn:se:uu:diva-6050 (URN)91-554-6384-3 (ISBN)
Public defence
2005-11-25, Robergsalen, Ingång 40, Akademiska sjukhuset, Uppsala, 13:15
Available from: 2005-11-03 Created: 2005-11-03 Last updated: 2013-06-20Bibliographically approved

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Björklund, ErikVenge, PerWallentin, LarsLindahl, Bertil
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