Evaluation of B-type natriuretic peptide for risk assessment in unstable angina/non-ST-elevation myocardial infarttion - B-Type natriuretic peptide and prognosis in TACTICS-TIMI 18
Evaluation of B-type natriuretic peptide for risk assessment in unstable angina/non-ST-elevation myocardial infarttion - B-Type natriuretic peptide and prognosis in TACTICS-TIMI 18
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DOI：
10.1016/s0735-1097(03)00168-2
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发表时间：
2003-04-16
影响因子：
24
通讯作者：
Braunwald, E
中科院分区：
文献类型：
--
作者：
Morrow, DA;de Lemos, JA;Braunwald, E
本研究旨在评估B型利钠肽（BNP）在非ST段抬高急性冠状动脉综合征（ACS）患者中的风险评估和临床决策制定中的作用，包括单独使用BNP和与心肌肌钙蛋白I（cTnI）联用。在接受临床用于ACS之前，需要有关最佳决策限制、与肌钙蛋白联合使用以及用于靶向治疗的更多证据。方法我们评估了1，676名非ST段抬高ACS患者的基线BNP，这些患者随机分为早期侵入性治疗和保守治疗。结果BNP升高的患者（>80 pg/ml; n = 320）在7天（2.5% vs. 0.7%，p = 0.006）和6个月（8.4% vs. 1.8%，p < 0.0001）时死亡风险较高。BNP与6个月时死亡率之间的相关性（校正比值比[OR] 3.3; 95%置信区间[CI] 1.7 - 6.3）独立于重要的临床预测因子，包括cTnI和充血性心力衰竭（CHF）。BNP升高的患者在30天内发生新发CHF的风险高5倍（5.9% vs. 1.0%，p < 0.0001）。B型利钠肽增加了cTnI的预后信息，在基线cTnI结果阴性（OR 6.9; 95% CI 1.9 - 25.8）和阳性（OR 4.1; 95% CI 1.9 - 9.0）的患者中区分死亡风险较高的患者。当按BNP基线水平分层时（P-相互作用大于或等于0.6），侵入性治疗与保守性治疗的效果无差异。结论BNP升高（>80 pg/ml）可识别非ST段抬高型ACS患者，其死亡和CHF风险较高，并增加cTnI的增量信息。需要开展更多工作来确定可能降低与BNP升高相关的风险的疗法。(C)2003年由美国心脏病学会基金会。
OBJECTIVES This study was designed to evaluate B-type natriuretic peptide (BNP) for risk assessment and clinical decision making over a range of cut points, alone and with cardiac troponin I (cTnI), in patients with non-ST-elevation acute coronary syndromes (ACS).BACKGROUND B-type natriuretic peptide holds promise for risk stratification. Additional evidence regarding optimal decision limits, use in combination with troponin, and use in targeting therapy is needed before acceptance into clinical use for ACS.METHODS We evaluated BNP at baseline in 1,676 patients with non-ST-elevation ACS randomized to early invasive versus conservative management.RESULTS Patients with elevated BNP (>80 pg/ml; n = 320) were at higher risk of death at seven days (2.5% vs. 0.7%, p = 0.006) and six months (8.4% vs. 1.8%, p < 0.0001). The association between BNP and mortality at six months (adjusted odds ratio [OR] 3.3; 95% confidence interval [CI] 1.7 to 6.3) was independent of important clinical predictors, including cTnI and congestive heart failure (CHF). Patients with elevated BNP had a fivefold higher risk of developing new CHF by 30 days (5.9% vs. 1.0%, p < 0.0001). B-type natriuretic peptide added prognostic information to cTnI, discriminating patients at higher mortality risk among those with negative (OR 6.9; 95% CI 1.9 to 25.8) and positive (OR 4.1; 95% CI 1.9 to 9.0) baseline cTnI results. No difference was observed in the effiect of invasive versus conservative management when stratified by baseline levels of BNP (P-interaction greater than or equal to 0.6).CONCLUSIONS Elevated BNP (>80 pg/ml) at presentation identifies patients with non-ST-elevation ACS who are at higher risk of death and CHF and adds incremental information to cTnI. Additional work is needed to identify therapies that may reduce the risk associated with increased BNP. (C) 2003 by the American College of Cardiology Foundation.