N-terminal pro brain natriuretic peptide on admission for early risk stratification of patients with chest pain and no ST-segment elevation
N-terminal pro brain natriuretic peptide on admission for early risk stratification of patients with chest pain and no ST-segment elevation
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DOI：
10.1016/s0735-1097(02)01986-1
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发表时间：
2002-08-07
影响因子：
24
通讯作者：
Lindahl, B
中科院分区：
文献类型：
--
作者：
Jernberg, T;Stridsberg, M;Lindahl, B
目的 该研究评估了入院时对有急性冠脉综合征症状但无 ST 段抬高的患者进行单次测量 N 末端脑钠肽前体 (NT-proBNP) 的预后价值。 背景 具有提示急性冠脉综合征症状但无 ST 段抬高的患者构成了一个庞大且异质的群体。早期风险分层基于临床背景因素、心电图（ECG）和心肌损伤的生化标志物。迄今为止，神经激素激活较少受到关注。方法对 755 例因胸痛且无 ST 段抬高入院的患者入院时进行 NT-proBNP 分析。对患者死亡进行了 40 个月的随访（中位）。 结果 NT-proBNP 水平中位为 400（111 至 1646）ng/l。与最低四分位数相比，第二、第三和第四四分位数的患者随后死亡的相对风险分别为4.2（1.6至11.1）、10.7（4.2至26.8）和26.6（10.8至65.5）。当 NT-proBNP 添加到包括临床背景因素、心电图和肌钙蛋白 T 的 Cox 回归模型中时，NT-proBNP 水平与预后独立相关。 结论 入院时单次测量 NT-proBNP 将显着改善具有提示急性冠脉综合征症状且无 ST 段抬高的患者的早期风险分层。入院时获得的临床背景因素、心电图、肌钙蛋白 T 和 NT-proBNP 的组合将为风险分层和进一步的临床决策提供高度辨别的工具。 (C) 2002 年由美国心脏病学会基金会资助。
OBJECTIVES The study evaluated the prognostic value of single measurement of N-terminal pro brain natriuretic peptide (NT-proBNP) obtained on admission in patients with symptoms suggestive of an acute coronary syndrome and no ST-segment elevation.BACKGROUND Patients with symptoms suggestive of an acute coronary syndrome and no ST-segment elevation constitute a large and heterogeneous population. Early risk stratification has been based on clinical background factors, electrocardiography (ECG) and biochemical markers of myocardial damage. The neurohormonal activation has, so far, received less attention.METHODS The NT-proBNP was analyzed on admission in 755 patients admitted because of chest pain and no ST-segment elevation. Patients were followed concerning death for 40 months (median).RESULTS The median NT-proBNP level was 400 (111 to 1646) ng/l. Compared to the lowest quartile, patients in the second, third and fourth quartiles had a relative risk of subsequent death of 4.2 (1.6 to 11.1), 10.7 (4.2 to 26.8) and 26.6 (10.8 to 65.5), respectively. When NT-proBNP was added to a Cox regression model including clinical background factors, ECG and troponin T, the NT-proBNP levels were independently associated with prognosis.CONCLUSIONS A single measurement of NT-proBNP on admission will substantially improve the early risk stratification of patients with symptoms suggestive of an acute coronary syndrome and no ST-segment elevation. A combination of clinical background factors, ECG, troponin T and NT-proBNP obtained on admission will provide a highly discerning tool for risk stratification and further clinical decisions. (C) 2002 by the American College of Cardiology Foundation.