NT-proBNP for prognostic and diagnostic evaluation in patients with acute coronary syndromes

Vladimir Zdravkovic, Violeta Mladenovic, Maja Colic, Dragic Bankovic, Zorica Lazic, Marina Petrovic, Ivan Simic, Slavko Knezevic, Sveto Pantovic, Aleksandar Djukic, Nemanja Zdravkovic

Abstract

Background and aim: N terminal-proB-type natriuretic peptide (NT-proBNP) is synthesised and secreted from the ventricularmyocardium. This marker is known to be elevated in patients with acute coronary syndromes (ACS). We evaluated NT-proBNP asa significant diagnostic marker and an important independent predictor of short-term mortality (one month) in patients with ACS.

Methods: NT-proBNP and cardiac troponin I (cTI) were assessed in 134 consecutive patients (median age 66 years, 73% male)hospitalised for ACS in a cardiological university department. The patients were classified into ST-elevation ACS (STE-ACS, n = 74) and non-ST-elevation ACS (NSTE-ACS, n = 60) groups based on the ECG findings on admission. Patients with Killipclass ≥ II were excluded.

Results: The serum level of NT-proBNP on admission was significantly higher (p < 0.0005), while there was no differencein cTI serum level in the NSTE-ACS patients compared to STE-ACS patients. There was a significant positive correlation betweenNT-proBNP and cTI in the NSTE-ACS (r = 0.338, p = 0.008) and STE-ACS (r = 0.441, p < 0.0005) patients. Therewas a significant difference in NT-proBNP (p < 0.0005) and cTI (p < 0.0005) serum level between ACS patients who diedwithin 30 days or who survived after one month. The increased NT-proBNP level is the strongest predictor of mortality in ACSpatients, also NT-proBNP cut-point level of 1,490 pg/mL is a significant independent predictor of mortality.

Conclusions: We demonstrated the differences and the correlation in the secretion of NT-proBNP and cTI in patients withSTE-ACS vs. NSTE-ACS. Our results provide evidence that NT-proBNP is a significant diagnostic marker and an importantindependent predictor of short-term mortality in patients with ACS.

Keywords

acute coronary syndromes, NT-proBNP, troponin I, prognosis

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