B-type natriuretic peptide in the early diagnosis and risk stratification of acute chest pain
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B-type natriuretic peptide in the early diagnosis and risk stratification of acute chest pain. / Haaf, Philip; Reichlin, Tobias; Corson, Nils; Twerenbold, Raphael; Reiter, Miriam; Steuer, Stephan; Bassetti, Stefano; Winkler, Katrin; Stelzig, Claudia; Heinisch, Corinna; Drexler, Beatrice; Freidank, Heike; Mueller, Christian.
in: AM J MED, Jahrgang 124, Nr. 5, 05.2011, S. 444-52.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - B-type natriuretic peptide in the early diagnosis and risk stratification of acute chest pain
AU - Haaf, Philip
AU - Reichlin, Tobias
AU - Corson, Nils
AU - Twerenbold, Raphael
AU - Reiter, Miriam
AU - Steuer, Stephan
AU - Bassetti, Stefano
AU - Winkler, Katrin
AU - Stelzig, Claudia
AU - Heinisch, Corinna
AU - Drexler, Beatrice
AU - Freidank, Heike
AU - Mueller, Christian
N1 - Copyright © 2011 Elsevier Inc. All rights reserved.
PY - 2011/5
Y1 - 2011/5
N2 - BACKGROUND: Myocardial ischemia is a strong trigger of B-type natriuretic peptide (BNP) release. As ischemia precedes necrosis in acute myocardial infarction, we hypothesized that BNP might be useful in the early diagnosis and risk stratification of patients with acute chest pain.METHODS: In a prospective, international multicenter study, BNP was measured in 1075 unselected patients with acute chest pain. The final diagnosis was adjudicated by 2 independent cardiologists. Patients were followed long term regarding mortality.RESULTS: Acute myocardial infarction was the adjudicated final diagnosis in 168 patients (16%). BNP levels at presentation were significantly higher in acute myocardial infarction as compared with patients with other diagnoses (median 224 pg/mL vs. 56 pg/mL, P <.001). The diagnostic accuracy of BNP for the diagnosis of acute myocardial infarction as quantified by the area under the receiver operating characteristic curve (AUC) (0.74; 95% confidence interval [CI], 0.70-0.78) was lower compared with cardiac troponin T at presentation (AUC 0.88; 95% CI, 0.84-0.92; P <.001). Cumulative 24-month mortality rates were 0.5% in the first, 2.1% in the second, 7.0% in the third, and 22.9% in the fourth quartile of BNP (P <.001). BNP predicted all-cause mortality independently of and more accurately than cardiac troponin T: AUC 0.81 (95% CI, 0.76-0.86) versus AUC 0.70 (95% CI, 0.62-0.77; P <.001). Net reclassification improvement for BNP was 0.10 (P=.04), and integrated discrimination improvement 0.068 (P=.01).CONCLUSIONS: BNP accurately predicts mortality in unselected patients with acute chest pain independently of and more accurately than cardiac troponin T, but does not seem to help in the early diagnosis of acute myocardial infarction.
AB - BACKGROUND: Myocardial ischemia is a strong trigger of B-type natriuretic peptide (BNP) release. As ischemia precedes necrosis in acute myocardial infarction, we hypothesized that BNP might be useful in the early diagnosis and risk stratification of patients with acute chest pain.METHODS: In a prospective, international multicenter study, BNP was measured in 1075 unselected patients with acute chest pain. The final diagnosis was adjudicated by 2 independent cardiologists. Patients were followed long term regarding mortality.RESULTS: Acute myocardial infarction was the adjudicated final diagnosis in 168 patients (16%). BNP levels at presentation were significantly higher in acute myocardial infarction as compared with patients with other diagnoses (median 224 pg/mL vs. 56 pg/mL, P <.001). The diagnostic accuracy of BNP for the diagnosis of acute myocardial infarction as quantified by the area under the receiver operating characteristic curve (AUC) (0.74; 95% confidence interval [CI], 0.70-0.78) was lower compared with cardiac troponin T at presentation (AUC 0.88; 95% CI, 0.84-0.92; P <.001). Cumulative 24-month mortality rates were 0.5% in the first, 2.1% in the second, 7.0% in the third, and 22.9% in the fourth quartile of BNP (P <.001). BNP predicted all-cause mortality independently of and more accurately than cardiac troponin T: AUC 0.81 (95% CI, 0.76-0.86) versus AUC 0.70 (95% CI, 0.62-0.77; P <.001). Net reclassification improvement for BNP was 0.10 (P=.04), and integrated discrimination improvement 0.068 (P=.01).CONCLUSIONS: BNP accurately predicts mortality in unselected patients with acute chest pain independently of and more accurately than cardiac troponin T, but does not seem to help in the early diagnosis of acute myocardial infarction.
KW - Acute Coronary Syndrome/blood
KW - Aged
KW - Aged, 80 and over
KW - Analysis of Variance
KW - Angina Pectoris/diagnosis
KW - Biomarkers/blood
KW - Chest Pain/blood
KW - Disease-Free Survival
KW - Early Diagnosis
KW - Female
KW - Humans
KW - Kaplan-Meier Estimate
KW - Male
KW - Middle Aged
KW - Myocardial Infarction/blood
KW - Natriuretic Peptide, Brain/blood
KW - Odds Ratio
KW - Predictive Value of Tests
KW - Risk Factors
KW - Troponin T/blood
U2 - 10.1016/j.amjmed.2010.11.012
DO - 10.1016/j.amjmed.2010.11.012
M3 - SCORING: Journal article
C2 - 21531234
VL - 124
SP - 444
EP - 452
JO - AM J MED
JF - AM J MED
SN - 0002-9343
IS - 5
ER -
