Risk assessment in patients with unstable angina/non-ST-elevation myocardial infarction and normal N-terminal pro-brain natriuretic peptide levels by N-terminal pro-atrial natriuretic peptide

• Published in: European heart journal 2005-02, Vol.26 (3), p.250-256
• Main Authors: Jarai, Rudolf, Iordanova, Nelly, Jarai, Robert, Raffetseder, Annamaria, Woloszczuk, Wolfgang, Gyöngyösi, Mariann, Geyer, Georg, Wojta, Johann, Huber, Kurt
• Format: Article
• Language: English
• Subjects: Acute coronary syndromes; Adult; Aged; Angina, Unstable - blood; Angina, Unstable - mortality; Atrial Natriuretic Factor - blood; Atrial natriuretic peptide; Biological and medical sciences; Brain natriuretic peptide; Cardiology. Vascular system; Coronary heart disease; Female; Heart; Humans; Male; Medical sciences; Middle Aged; Myocardial Infarction - blood; Myocardial Infarction - mortality; Myocarditis. Cardiomyopathies; Natriuretic Peptide, Brain; Nerve Tissue Proteins - blood; Peptide Fragments - blood; Protein Precursors - blood; Regression Analysis; Risk Assessment - methods; Risk Factors; Risk prediction; Sensitivity and Specificity; Statistics, Nonparametric; Troponin I; Troponin I - blood
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/eurheartj/ehi038

Aims To compare the accuracy of the N-terminal fragment of its pro-hormone (Nt-proBNP) and N-terminal pro-atrial natriuretic peptide (Nt-proANP) in the prediction of the 2 year mortality and to investigate whether additional measurement of Nt-proANP to troponin I (TnI) could improve risk assessment in the subgroups of patients with unstable coronary artery disease (UCAD) and normal Nt-proBNP. Methods and results Plasma levels of the TnI, Nt-proANP, and Nt-proBNP were determined in 120 consecutive patients with UCAD without ST-segment elevations and normal left ventricular function. In multivariable logistic regression analysis, TnI and Nt-proBNP were independent predictors of mortality (P=0.01 and P=0.02, respectively). However, in the group of patients with normal Nt-proBNP levels, only Nt-proANP and TnI were independently associated with mortality (P=0.007 and P=0.03, respectively). Accordingly, patients with elevated Nt-proANP levels in this group of patients had significantly higher mortality rate than patients with normal Nt-proANP levels (P=0.003). Conclusion Our results suggest that determination of Nt-proANP might improve risk assessment in patients with UCAD, especially when Nt-proBNP is in the normal range.