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
2006 (English)In: Heart, ISSN 1355-6037, E-ISSN 1468-201X, Vol. 92, no 6, 735-740 p.Article in journal (Refereed) Published
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.
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
Medical and Health Sciences
IdentifiersURN: urn:nbn:se:uu:diva-23949DOI: 10.1136/hrt.2005.072975PubMedID: 16251228OAI: oai:DiVA.org:uu-23949DiVA: diva2:51723