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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.
Heart 2006; 92(6):735-40H

Abstract

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 < or = 65 years, < or = 184 ng/l and < or = 268 ng/l and for those > 65 years, < or = 269 ng/l and < or = 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 microg/l was used. Of the 782 patients, 456 had ST segment resolution (< 50% or > 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.

Authors+Show Affiliations

Department of Cardiology, University Hospital of Uppsala, Uppsala, Sweden. erik.bjorklund@akademiska.seNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16251228

Citation

Björklund, E, et al. "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." Heart (British Cardiac Society), vol. 92, no. 6, 2006, pp. 735-40.
Björklund E, Jernberg T, Johanson P, et al. 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. Heart. 2006;92(6):735-40.
Björklund, E., Jernberg, T., Johanson, P., Venge, P., Dellborg, M., Wallentin, L., & Lindahl, B. (2006). 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. Heart (British Cardiac Society), 92(6), pp. 735-40.
Björklund E, et al. 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. Heart. 2006;92(6):735-40. PubMed PMID: 16251228.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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. AU - Björklund,E, AU - Jernberg,T, AU - Johanson,P, AU - Venge,P, AU - Dellborg,M, AU - Wallentin,L, AU - Lindahl,B, AU - ,, Y1 - 2005/10/26/ PY - 2005/10/28/pubmed PY - 2006/6/20/medline PY - 2005/10/28/entrez SP - 735 EP - 40 JF - Heart (British Cardiac Society) JO - Heart VL - 92 IS - 6 N2 - 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 < or = 65 years, < or = 184 ng/l and < or = 268 ng/l and for those > 65 years, < or = 269 ng/l and < or = 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 microg/l was used. Of the 782 patients, 456 had ST segment resolution (< 50% or > 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. SN - 1468-201X UR - https://www.unboundmedicine.com/medline/citation/16251228/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_ L2 - http://heart.bmj.com/cgi/pmidlookup?view=long&amp;pmid=16251228 DB - PRIME DP - Unbound Medicine ER -