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Circulation. 2002;106:2913-2918
Published online before print November 11, 2002, doi: 10.1161/01.CIR.0000041661.63285.AE
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(Circulation. 2002;106:2913.)
© 2002 American Heart Association, Inc.

Clinical Investigation and Reports

N-Terminal Pro-B–Type Natriuretic Peptide and Long-Term Mortality in Acute Coronary Syndromes

Torbjørn Omland, MD, PhD, MPH; Anita Persson, MSc; Leong Ng, MD, PhD; Russel O’Brien, MD; Thomas Karlsson, MSc; Johan Herlitz, MD, PhD; Marianne Hartford, MD, PhD; Kenneth Caidahl, MD, PhD

From the Department of Cardiology, National Hospital (T.O.), Oslo, Norway; Departments of Cardiology (M.H., J.H., T.K.) and Clinical Physiology (A.P., K.C.), Sahlgrenska University Hospital, Göteborg, Sweden; and Department of Medicine and Therapeutics (R.O.B., L.N.), University of Leicester, Leicester, UK.

Correspondence to Kenneth Caidahl, MD, PhD, Department of Clinical Physiology, Sahlgrenska University Hospital, SE-41345 Göteborg, Sweden. E-mail caidahl{at}clinphys.gu.se

Background— B-type natriuretic peptide (BNP) is a predictor of short- and medium-term prognosis across the spectrum of acute coronary syndromes (ACS). The N-terminal fragment of the BNP prohormone, N-BNP, may be an even stronger prognostic marker. We assessed the relation between subacute plasma N-BNP levels and long-term, all-cause mortality in a large, contemporary cohort of patients with ACS.

Methods and Results— Blood samples for N-BNP determination were obtained in the subacute phase in 204 patients with ST-elevation myocardial infarction (MI): 220 with non-ST segment elevation MI and 185 with unstable angina in the subacute phase. After a median follow-up of 51 months, 86 patients (14%) had died. Median N-BNP levels were significantly lower in long-term survivors than in patients dying (442 versus 1306 pmol/L; P<0.0001). The unadjusted risk ratio of patients with supramedian N-BNP levels was 3.9 (95% confidence interval, 2.4 to 6.5). In a multivariate Cox regression model, N-BNP (risk ratio 2.1 [95% confidence interval, 1.1 to 3.9]) added prognostic information above and beyond Killip class, patient age, and left ventricular ejection fraction. Adjustment for peak troponin T levels did not markedly alter the relation between N-BNP and mortality. In patients with no evidence of clinical heart failure, N-BNP remained a significant predictor of mortality after adjustment for age and ejection fraction (risk ratio, 2.4 [95% confidence interval, 1.1 to 5.4]).

Conclusions— N-BNP is a powerful indicator of long-term mortality in patients with ACS and provides prognostic information above and beyond conventional risk markers.


Key Words: angina • myocardial infarction • natriuretic peptides • prognosis • risk factors


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Brain Natriuretic Peptide Measurement in Acute Coronary Syndromes: Ready for Clinical Application?
James A. de Lemos and David A. Morrow
Circulation 2002 106: 2868-2870. [Full Text]



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