N-terminal pro-B-type natriuretic peptide and long-term mortality in acute coronary syndromes

被引:492
作者
Omland, T
Persson, A
Ng, L
O'Brien, R
Karlsson, T
Herlitz, J
Hartford, M
Caidahl, K [1 ]
机构
[1] Sahlgrens Univ Hosp, Dept Clin Physiol, SE-41345 Gothenburg, Sweden
[2] Sahlgrens Univ Hosp, Dept Cardiol, SE-41345 Gothenburg, Sweden
[3] Natl Hosp Norway, Dept Cardiol, Oslo, Norway
[4] Univ Leicester, Dept Med & Therapeut, Leicester LE1 7RH, Leics, England
关键词
angina; myocardial infarction; natriuretic peptides; prognosis; risk factors;
D O I
10.1161/01.CIR.0000041661.63285.AE
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background-B-type natriuretic peptide (BNP) is a predictor of short- and medium-term prognosis across the spectrum of acute coronary syndromes (ACS). The N-terminal fragment of the BNP prohormone, N-BNP, may be an even stronger prognostic marker. We assessed the relation between subacute plasma N-BNP levels and long-term, all-cause mortality in a large, contemporary cohort of patients with ACS. Methods and Results-Blood samples for N-BNP determination were obtained in the subacute phase in 204 patients with ST-elevation myocardial infarction (MI): 220 with non-ST segment elevation MI and 185 with unstable angina in the subacute phase. After a median follow-up of 51 months, 86 patients (14%) had died. Median N-BNP levels were significantly lower in long-term survivors than in patients dying (442 versus 1306 pmol/L; P < 0.0001). The unadjusted risk ratio of patients with supramedian N-BNP levels was 3.9 (95% confidence interval, 2.4 to 6.5). In a multivariate Cox regression model, N-BNP (risk ratio 2.1 [95% confidence interval, 1.1 to 3.9]) added prognostic information above and beyond Killip class, patient age, and left ventricular ejection fraction. Adjustment for peak troponin T levels did not markedly alter the relation between N-BNP and mortality. In patients with no evidence of clinical heart failure, N-BNP remained a significant predictor of mortality after adjustment for age and ejection fraction (risk ratio, 2.4 [95% confidence interval, 1.1 to 5.4]). Conclusions-N-BNP is a powerful indicator of long-term mortality in patients with ACS and provides prognostic information above and beyond conventional risk markers.
引用
收藏
页码:2913 / 2918
页数:6
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