2006•Zhonghua xinxueguanbing zazhiRequires access
The value of blood brain natriuretic peptide for predicting clinical severity and prognosis in patients with acute coronary syndromes
Zhenwen Huang, Xincan Liu, Chunguang Qiu, Tongwen Sun, Yanzhou Zhang, Mingjun Zhu, Lexin Wang
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Abstract
Background: B-type/brain natriuretic peptide (BNP) is a neurohormone synthesized predominantly in ventricular myocardium. Although the circulating level of this neurohormone has been shown to provide independent prognostic information in patients with heart failure, few data are available for Chinese patients with acute coronary syndromes (ACS). This study was designed to investigate the value of blood BNP for predicting clinical severity and prognosis in patients with ACS. Methods: Blood BNP concentration was measured in 106 ACS patients, 1-3 days after onset of ischemic symptoms. Patients were followed up for six months. The end-point were cardiac death, non-fetal myocardial infarction and readmission. Results: (1) The concentration of circulating BNP in patients with ACS were increased. (2) 1 month follow-up demonstrated that, levels of BNP in non- survivals were much higher than that in survivals (P<0.0005); step-wise logistic regression analysis demonstrated that ST segment deviation ≥ 1 mm and BNP ≥ 596 ng/L were independent predictors of short-term cardiac death in patients with ACS (OR=3.467, 95% confidence interval (CI) 1.336-32.836, P=0.002; OR=21.168, 95% CI 4.419-107.990, P<0.0005). (3) area under the curve(AUC) of the receiver-operating-characteristic (ROC) of BNP to predict short-term cardiac death in patients with ACS was 0.878(95% CI 0.781-0.974, P<0.0005). (4) Kaplan-Meier survival curve showed that the survival curve of patients with BNP above 596 ng/L was significantly lower than that of patients with BNP below 596 ng/L(Log-rank test, P<0.0005). Cox proportional hazards regression models demonstrated that BNP and cardiac troponin I were risk factors which related to ACS prognosis (RR = 2.507, 95% CI 1.081-3.914, P =0.028; RR =2.208, 95% CI 1.609-3.874, P=0.030). Conclusions: (1) The circulating levels of BNP are significantly increased in patients with ACS. Myocardial ischemia and / or left ventricular systolic dysfunction are the main cause of stimulating BNP secretion. (2) BNP could provide important clinical value for predicting clinical severity and prognosis. It could be used for risk stratification in patients with ACS, especially when there is only ischemia without infarction and when blood is sampled very early after the onset of ischemia that would be missed by markers of myocyte necrosis. (Tong-wen Sun,Shu-xiang Zhang, Qing-yan Xu,Xiao-juan Zhang,Ling Li,Jin-ying Zhang. The value of blood brain natriuretic peptide for predicting clinical severity and prognosis in patients with acute coronary syndromes. Life Science Journal 2010;7(4):119-123). (ISSN: 1097-8135).