Prognostic value of serial BNP measurements in patients with acute coronary syndromes

Objective To evaluate the relationship between serial BNP measurements and cardiovascular events in patients with acute coronary syndromes(ACS). Methods BNP, troponin T(TnT) and C-reactive protein(CRP) were measured at baseline and at 48 and 72 hours in 83 patients with ACS. Death and myocardial infarction were recorded during 12 months of follow-up. Statistical analysis was done. Results For the later follow-up, baseline BNP levels higher were associated with higher event rates, event rates were significantly higher in patients with BNP250 ng/L than the patients with BNP≤250 ng/L(9% vs 27%,OR 3.7,95%CI:2.3-5.7,P0.01). In troponin T negative patients,BNP identified a subgroup of high-risk patients (OR,5.9,95% CI, 2.6 to 13.3,P0.01). Importantly,clinical stabilization without refractory ischemia was associated with a rapid and significant(48 hours,-24%,72 hours,-49%,both P0.001) decline in BNP levels. In patients with high BNP baseline levels, lack of a rapid decline in BNP levels was linked to an adverse short-term prognosis(OR 18.5,95% CI:7.6 to 21.3,P0.01). In patients with low BNP baseline levels, a rise in BNP levels over 72 hours was also linked to an adverse prognosis (OR 24.0,95% CI:8.4 to 32.5,P0.01). Conclusion BNP is a powerful and independent determinant of the short-term cardiac risk in patients with ACS, and serial BNP measurements are superior to a single BNP value obtained at baseline.