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N-terminal pro-brain natriuretic peptide for additional risk stratification in patients with non-ST-elevation acute coronary syndrome and an elevated troponin T: an Invasive versus Conservative Treatment in Unstable coronary Syndromes (ICTUS) substudy.
Am Heart J 2007; 153(4):485-92AH

Abstract

BACKGROUND

New evidence has emerged that the assessment of multiple biomarkers such as cardiac troponin T (cTnT) and N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with non-ST-elevation acute coronary syndrome (nSTE-ACS) provides unique prognostic information. The purpose of this study was to assess the association between baseline NT-proBNP levels and outcome in patients who have nSTE-ACS with an elevated cTnT and to determine whether patients with elevated NT-proBNP levels benefit from an early invasive treatment strategy.

METHODS

Baseline samples for NT-proBNP measurements were available in 1141 patients who have nSTE-ACS with an elevated cTnT randomized to an early or a selective invasive strategy. Patients were followed-up for the occurrence of death, myocardial infarction (MI), and rehospitalization for angina.

RESULTS

We showed that increased levels of NT-proBNP were associated with several indicators of risk and severe coronary artery disease. Mortality by 1 year was 7.3% in the highest quartile (> or = 1170 ng/L for men, > or = 2150 ng/L for women) compared with 1.1% of patients in the lower 3 quartiles (P < .0001). N-terminal pro-brain natriuretic peptide (highest quartile vs lower 3 quartiles) was a strong independent predictor of mortality (hazard ratio 5.0, 95% CI 2.1-11.6, P = .0002). However, NT-proBNP levels were not associated with the incidence of recurrent MI by 1 year. Furthermore, we could not demonstrate a benefit of an early invasive strategy compared with a selective invasive strategy in patients with an elevated NT-proBNP level.

CONCLUSIONS

We confirmed that NT-proBNP is a strong independent predictor of mortality by 1 year but not of recurrent MI in patients who have nSTE-ACS with an elevated cTnT. We could not demonstrate a benefit of an early invasive strategy compared with a selective invasive strategy.

Authors+Show Affiliations

Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands.No affiliation info availableNo affiliation info availableNo 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
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17383283

Citation

Windhausen, Fons, et al. "N-terminal Pro-brain Natriuretic Peptide for Additional Risk Stratification in Patients With non-ST-elevation Acute Coronary Syndrome and an Elevated Troponin T: an Invasive Versus Conservative Treatment in Unstable Coronary Syndromes (ICTUS) Substudy." American Heart Journal, vol. 153, no. 4, 2007, pp. 485-92.
Windhausen F, Hirsch A, Sanders GT, et al. N-terminal pro-brain natriuretic peptide for additional risk stratification in patients with non-ST-elevation acute coronary syndrome and an elevated troponin T: an Invasive versus Conservative Treatment in Unstable coronary Syndromes (ICTUS) substudy. Am Heart J. 2007;153(4):485-92.
Windhausen, F., Hirsch, A., Sanders, G. T., Cornel, J., Fischer, J., van Straalen, J. P., ... de Winter, R. J. (2007). N-terminal pro-brain natriuretic peptide for additional risk stratification in patients with non-ST-elevation acute coronary syndrome and an elevated troponin T: an Invasive versus Conservative Treatment in Unstable coronary Syndromes (ICTUS) substudy. American Heart Journal, 153(4), pp. 485-92.
Windhausen F, et al. N-terminal Pro-brain Natriuretic Peptide for Additional Risk Stratification in Patients With non-ST-elevation Acute Coronary Syndrome and an Elevated Troponin T: an Invasive Versus Conservative Treatment in Unstable Coronary Syndromes (ICTUS) Substudy. Am Heart J. 2007;153(4):485-92. PubMed PMID: 17383283.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - N-terminal pro-brain natriuretic peptide for additional risk stratification in patients with non-ST-elevation acute coronary syndrome and an elevated troponin T: an Invasive versus Conservative Treatment in Unstable coronary Syndromes (ICTUS) substudy. AU - Windhausen,Fons, AU - Hirsch,Alexander, AU - Sanders,Gerard T, AU - Cornel,Jan Hein, AU - Fischer,Johan, AU - van Straalen,Jan P, AU - Tijssen,Jan G P, AU - Verheugt,Freek W A, AU - de Winter,Robbert J, AU - ,, PY - 2006/08/22/received PY - 2006/12/17/accepted PY - 2007/3/27/pubmed PY - 2007/5/4/medline PY - 2007/3/27/entrez SP - 485 EP - 92 JF - American heart journal JO - Am. Heart J. VL - 153 IS - 4 N2 - BACKGROUND: New evidence has emerged that the assessment of multiple biomarkers such as cardiac troponin T (cTnT) and N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with non-ST-elevation acute coronary syndrome (nSTE-ACS) provides unique prognostic information. The purpose of this study was to assess the association between baseline NT-proBNP levels and outcome in patients who have nSTE-ACS with an elevated cTnT and to determine whether patients with elevated NT-proBNP levels benefit from an early invasive treatment strategy. METHODS: Baseline samples for NT-proBNP measurements were available in 1141 patients who have nSTE-ACS with an elevated cTnT randomized to an early or a selective invasive strategy. Patients were followed-up for the occurrence of death, myocardial infarction (MI), and rehospitalization for angina. RESULTS: We showed that increased levels of NT-proBNP were associated with several indicators of risk and severe coronary artery disease. Mortality by 1 year was 7.3% in the highest quartile (> or = 1170 ng/L for men, > or = 2150 ng/L for women) compared with 1.1% of patients in the lower 3 quartiles (P < .0001). N-terminal pro-brain natriuretic peptide (highest quartile vs lower 3 quartiles) was a strong independent predictor of mortality (hazard ratio 5.0, 95% CI 2.1-11.6, P = .0002). However, NT-proBNP levels were not associated with the incidence of recurrent MI by 1 year. Furthermore, we could not demonstrate a benefit of an early invasive strategy compared with a selective invasive strategy in patients with an elevated NT-proBNP level. CONCLUSIONS: We confirmed that NT-proBNP is a strong independent predictor of mortality by 1 year but not of recurrent MI in patients who have nSTE-ACS with an elevated cTnT. We could not demonstrate a benefit of an early invasive strategy compared with a selective invasive strategy. SN - 1097-6744 UR - https://www.unboundmedicine.com/medline/citation/17383283/N_terminal_pro_brain_natriuretic_peptide_for_additional_risk_stratification_in_patients_with_non_ST_elevation_acute_coronary_syndrome_and_an_elevated_troponin_T:_an_Invasive_versus_Conservative_Treatment_in_Unstable_coronary_Syndromes__ICTUS__substudy_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-8703(06)01069-6 DB - PRIME DP - Unbound Medicine ER -