N-terminal pro B-type natriuretic peptide in the early evaluation of suspected acute myocardial infarction
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N-terminal pro B-type natriuretic peptide in the early evaluation of suspected acute myocardial infarction. / Haaf, Philip; Balmelli, Cathrin; Reichlin, Tobias; Twerenbold, Raphael; Reiter, Miriam; Meissner, Julia; Schaub, Nora; Stelzig, Claudia; Freese, Michael; Paniz, Patricia; Meune, Christophe; Drexler, Beatrice; Freidank, Heike; Winkler, Katrin; Hochholzer, Willibald; Mueller, Christian.
In: AM J MED, Vol. 124, No. 8, 08.2011, p. 731-9.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - N-terminal pro B-type natriuretic peptide in the early evaluation of suspected acute myocardial infarction
AU - Haaf, Philip
AU - Balmelli, Cathrin
AU - Reichlin, Tobias
AU - Twerenbold, Raphael
AU - Reiter, Miriam
AU - Meissner, Julia
AU - Schaub, Nora
AU - Stelzig, Claudia
AU - Freese, Michael
AU - Paniz, Patricia
AU - Meune, Christophe
AU - Drexler, Beatrice
AU - Freidank, Heike
AU - Winkler, Katrin
AU - Hochholzer, Willibald
AU - Mueller, Christian
N1 - Copyright © 2011 Elsevier Inc. All rights reserved.
PY - 2011/8
Y1 - 2011/8
N2 - BACKGROUND: Myocardial ischemia is a strong trigger of N-terminal pro-B-type natriuretic peptide (NT-proBNP) release. As ischemia precedes necrosis in acute myocardial infarction, we hypothesized that NT-proBNP might be useful in the early diagnosis and risk stratification of patients with suspected acute myocardial infarction.METHODS: In a prospective multicenter study, NT-proBNP was measured at presentation in 658 consecutive 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 117 patients (18%). NT-proBNP levels at presentation were significantly higher in acute myocardial infarction as compared with patients with other final diagnoses (median 886 pg/mL vs 135 pg/mL, P <.001). The diagnostic accuracy of NT-proBNP for acute myocardial infarction as quantified by the area under the receiver operating characteristic curve (AUC) was 0.79 (95% confidence interval [CI], 0.75-0.83). When added to cardiac troponin T, NT-proBNP significantly increased the AUC from 0.89 (95% CI, 0.84-0.93) to 0.91 (95% CI, 0.88-0.94; P=.033). Cumulative 24-month mortality rates were 0% in the first, 1.3% in the second, 8.3% in the third, and 23.3% in the fourth quartile of NT-proBNP (P <.001). NT-proBNP (AUC 0.85, 95% CI, 0.81-0.89) predicted all-cause mortality independently of and more accurately than both cardiac troponin T (AUC 0.66, 95% CI, 0.58-0.74; P <.001) and the Thrombolysis in Myocardial Infarction risk score (AUC 0.79, 95% CI, 0.74-0.84; P <.001). Net reclassification improvement (Thrombolysis in Myocardial Infarction vs additionally NT-proBNP) was 0.188 (P <.009), and integrated discrimination improvement was 0.100 (P <.001).CONCLUSIONS: Use of NT-proBNP improves the early diagnosis and risk stratification of patients with suspected acute myocardial infarction.
AB - BACKGROUND: Myocardial ischemia is a strong trigger of N-terminal pro-B-type natriuretic peptide (NT-proBNP) release. As ischemia precedes necrosis in acute myocardial infarction, we hypothesized that NT-proBNP might be useful in the early diagnosis and risk stratification of patients with suspected acute myocardial infarction.METHODS: In a prospective multicenter study, NT-proBNP was measured at presentation in 658 consecutive 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 117 patients (18%). NT-proBNP levels at presentation were significantly higher in acute myocardial infarction as compared with patients with other final diagnoses (median 886 pg/mL vs 135 pg/mL, P <.001). The diagnostic accuracy of NT-proBNP for acute myocardial infarction as quantified by the area under the receiver operating characteristic curve (AUC) was 0.79 (95% confidence interval [CI], 0.75-0.83). When added to cardiac troponin T, NT-proBNP significantly increased the AUC from 0.89 (95% CI, 0.84-0.93) to 0.91 (95% CI, 0.88-0.94; P=.033). Cumulative 24-month mortality rates were 0% in the first, 1.3% in the second, 8.3% in the third, and 23.3% in the fourth quartile of NT-proBNP (P <.001). NT-proBNP (AUC 0.85, 95% CI, 0.81-0.89) predicted all-cause mortality independently of and more accurately than both cardiac troponin T (AUC 0.66, 95% CI, 0.58-0.74; P <.001) and the Thrombolysis in Myocardial Infarction risk score (AUC 0.79, 95% CI, 0.74-0.84; P <.001). Net reclassification improvement (Thrombolysis in Myocardial Infarction vs additionally NT-proBNP) was 0.188 (P <.009), and integrated discrimination improvement was 0.100 (P <.001).CONCLUSIONS: Use of NT-proBNP improves the early diagnosis and risk stratification of patients with suspected acute myocardial infarction.
KW - Aged
KW - Aged, 80 and over
KW - Angina Pectoris/blood
KW - Area Under Curve
KW - Biomarkers/blood
KW - Confounding Factors, Epidemiologic
KW - Early Diagnosis
KW - Female
KW - Humans
KW - International Cooperation
KW - Male
KW - Middle Aged
KW - Multivariate Analysis
KW - Myocardial Infarction/blood
KW - Natriuretic Peptide, Brain/blood
KW - Odds Ratio
KW - Peptide Fragments/blood
KW - Predictive Value of Tests
KW - Prognosis
KW - Prospective Studies
KW - ROC Curve
KW - Risk Assessment
KW - Risk Factors
KW - Thrombolytic Therapy
KW - Treatment Outcome
KW - Troponin T/blood
U2 - 10.1016/j.amjmed.2011.02.035
DO - 10.1016/j.amjmed.2011.02.035
M3 - SCORING: Journal article
C2 - 21787902
VL - 124
SP - 731
EP - 739
JO - AM J MED
JF - AM J MED
SN - 0002-9343
IS - 8
ER -
