B-type natriuretic peptide: a novel early blood marker of acute myocardial infarction in patients with chest pain and no ST segment elevation
B-type natriuretic peptide: a novel early blood marker of acute myocardial infarction in patients with chest pain and no ST segment elevation
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DOI：
10.1093/eurheartj/ehi033
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发表时间：
2005-02-01
影响因子：
39.3
通讯作者：
Moutinho, MA
中科院分区：
文献类型：
--
作者：
Bassan, R;Potsch, A;Moutinho, MA
目的 本研究旨在确定入院时 B 型利钠肽 (BNP) 对急性胸痛且无 ST 段抬高患者的急性心肌梗死 (AMI) 的诊断价值。 方法和结果 对急诊科连续 631 例患者进行前瞻性研究。 72 名患者存在非 ST 段抬高 AMI，其入院时中位 BNP 水平显着高于不稳定型心绞痛和非急性冠脉综合征患者。入院时 BNP 对 AMI 的敏感性（截止值为 100 pg/mL）显着高于入院时肌酸激酶 MB (CKMB) 和肌钙蛋白 I（分别为 70.8% vs. 45.8% vs. 50.7%，P < 0.0001），特异性为 68.9%。同时使用这些标记物可将敏感性显着提高至 87.3%，阴性预测值显着提高至 97.3%。在多重 Logistic 回归分析中，即使模型中存在 CKMB 和肌钙蛋白 I，入院 BNP 也是 AMI 的重要独立预测因子。结论 对于因胸痛且无 ST 段抬高而到急诊科就诊的患者，BNP 是标准心脏标志物的有用辅助手段，特别是在初始 CKMB 和/或肌钙蛋白 I 无法诊断的情况下。
Aims This study was undertaken to determine the diagnostic value of admission B-type natriuretic peptide (BNP) for acute myocardial infarction (AMI) in patients with acute chest pain and no ST-segment elevation.Methods and results A prospective study with 631 consecutive patients was conducted in the emergency department. Non-ST elevation AMI was present in 72 patients and their median admission BNP level was significantly higher than in unstable angina and non-acute coronary syndrome patients. Sensitivity of admission BNP for AMI (cutoff value of 100 pg/mL) was significantly higher than creatine kinase-MB (CKMB) and troponin-I on admission (70.8 vs. 45.8 vs. 50.7%, respectively, P < 0.0001) and specificity was 68.9%. Simultaneous use of these markers significantly improved sensitivity to 87.3% and the negative predictive value to 97.3%. In multiple logistic regression analysis, admission BNP was a significant independent predictor of AMI, even when CKMB and troponin-I were present in the model.Conclusion BNP is a useful adjunct to standard cardiac markers in patients presenting to the emergency department with chest pain and no ST-segment elevation, particularly if initial CKMB and/or troponin-I are non-diagnostic.