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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


Related Article:

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. [Extract] [Full Text]



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Eur J Heart FailHome page
A. Cochet, M. Zeller, Y. Cottin, C. Robert-Valla, A. Lalande, I. L'Huilllier, A. Comte, P. M. Walker, J. Desgres, J.-E. Wolf, et al.
The extent of myocardial damage assessed by contrast-enhanced MRI is a major determinant of N-BNP concentration after myocardial infarction
Eur J Heart Fail, August 1, 2004; 6(5): 555 - 560.
[Abstract] [Full Text] [PDF]


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CirculationHome page
M. Galvani, F. Ottani, L. Oltrona, D. Ardissino, G. F. Gensini, A. P. Maggioni, P. M. Mannucci, N. Mininni, M. D. Prando, M. Tubaro, et al.
N-Terminal Pro-Brain Natriuretic Peptide on Admission Has Prognostic Value Across the Whole Spectrum of Acute Coronary Syndromes
Circulation, July 13, 2004; 110(2): 128 - 134.
[Abstract] [Full Text] [PDF]


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HeartHome page
M R Cowie
B type natriuretic peptide testing: where are we now?
Heart, July 1, 2004; 90(7): 725 - 726.
[Abstract] [Full Text] [PDF]


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Journal of Renin-Angiotensin-Aldosterone SystemHome page
A. Sharp and J. Mayet
Review: The utility of BNP in clinical practice
Journal of Renin-Angiotensin-Aldosterone System, June 1, 2004; 5(2): 53 - 58.
[Abstract] [PDF]


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Eur Heart JHome page
O. Bazzino, J. J Fuselli, F. Botto, D. Perez de Arenaza, C. Bahit, J. Dadone, and for the PACS group of investigators
Relative value of N-terminal probrain natriuretic peptide, TIMI risk score, ACC/AHA prognostic classification and other risk markers in patients with non-ST-elevation acute coronary syndromes
Eur. Heart J., May 2, 2004; 25(10): 859 - 866.
[Abstract] [Full Text] [PDF]


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Eur Heart JHome page
J. P. Goetze, W. Yongzhong, J. F Rehfeld, E. Jorgensen, and J. Kastrup
Coronary angiography transiently increases plasma pro-B-type natriuretic peptide
Eur. Heart J., May 1, 2004; 25(9): 759 - 764.
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Eur J Heart FailHome page
Y. Seino, A. Ogawa, T. Yamashita, M. Fukushima, K.-i. Ogata, H. Fukumoto, and T. Takano
Application of NT-proBNP and BNP measurements in cardiac care: a more discerning marker for the detection and evaluation of heart failure
Eur J Heart Fail, March 15, 2004; 6(3): 295 - 300.
[Abstract] [Full Text] [PDF]


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Eur J Heart FailHome page
M. Galvani, D. Ferrini, and F. Ottani
Natriuretic peptides for risk stratification of patients with acute coronary syndromes
Eur J Heart Fail, March 15, 2004; 6(3): 327 - 333.
[Abstract] [Full Text] [PDF]


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ChestHome page
S. de Denus, C. Pharand, and D. R. Williamson
Brain Natriuretic Peptide in the Management of Heart Failure: The Versatile Neurohormone
Chest, February 1, 2004; 125(2): 652 - 668.
[Abstract] [Full Text] [PDF]


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Clin. Chem.Home page
A. Clerico and M. Emdin
Diagnostic Accuracy and Prognostic Relevance of the Measurement of Cardiac Natriuretic Peptides: A Review
Clin. Chem., January 1, 2004; 50(1): 33 - 50.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
T. Jernberg, B. Lindahl, A. Siegbahn, B. Andren, G. Frostfeldt, B. Lagerqvist, M. Stridsberg, P. Venge, and L. Wallentin
N-terminal pro-brain natriuretic peptide in relation to inflammation, myocardial necrosis, and the effect of an invasive strategy in unstable coronary artery disease
J. Am. Coll. Cardiol., December 3, 2003; 42(11): 1909 - 1916.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
H. D. White and J. K. French
Use of brain natriuretic peptide levels for risk assessment in non-ST-elevation acute coronary syndromes
J. Am. Coll. Cardiol., December 3, 2003; 42(11): 1917 - 1920.
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Eur J Heart FailHome page
L. L. Ng, I. Loke, J. E. Davies, K. Khunti, M. Stone, K. R. Abrams, D. T. Chin, and I. B. Squire
Identification of previously undiagnosed left ventricular systolic dysfunction: community screening using natriuretic peptides and electrocardiography
Eur J Heart Fail, December 1, 2003; 5(6): 775 - 782.
[Abstract] [Full Text] [PDF]


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Eur Respir JHome page
P. Pruszczyk, M. Kostrubiec, A. Bochowicz, G. Styczynski, M. Szulc, M. Kurzyna, A. Fijalkowska, A. Kuch-Wocial, I. Chlewicka, and A. Torbicki
N-terminal pro-brain natriuretic peptide in patients with acute pulmonary embolism
Eur. Respir. J., October 1, 2003; 22(4): 649 - 653.
[Abstract] [Full Text] [PDF]


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Eur Heart JHome page
M.R Cowie, P Jourdain, A Maisel, U Dahlstrom, F Follath, R Isnard, A Luchner, T McDonagh, J Mair, M Nieminen, et al.
Clinical applications of B-type natriuretic peptide (BNP) testing
Eur. Heart J., October 1, 2003; 24(19): 1710 - 1718.
[Abstract] [Full Text] [PDF]


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CirculationHome page
S. K. James, B. Lindahl, A. Siegbahn, M. Stridsberg, P. Venge, P. Armstrong, E. S. Barnathan, R. Califf, E. J. Topol, M. L. Simoons, et al.
N-Terminal Pro-Brain Natriuretic Peptide and Other Risk Markers for the Separate Prediction of Mortality and Subsequent Myocardial Infarction in Patients With Unstable Coronary Artery Disease: A Global Utilization of Strategies To Open occluded arteries (GUSTO)-IV Substudy
Circulation, July 22, 2003; 108(3): 275 - 281.
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CirculationHome page
A. M. Richards, M. G. Nicholls, E. A. Espiner, J. G. Lainchbury, R. W. Troughton, J. Elliott, C. Frampton, J. Turner, I. G. Crozier, and T. G. Yandle
B-Type Natriuretic Peptides and Ejection Fraction for Prognosis After Myocardial Infarction
Circulation, June 10, 2003; 107(22): 2786 - 2792.
[Abstract] [Full Text] [PDF]


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Endocr. Rev.Home page
H. Ruskoaho
Cardiac Hormones as Diagnostic Tools in Heart Failure
Endocr. Rev., June 1, 2003; 24(3): 341 - 356.
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CirculationHome page
J. A. de Lemos and D. A. Morrow
Brain Natriuretic Peptide Measurement in Acute Coronary Syndromes: Ready for Clinical Application?
Circulation, December 3, 2002; 106(23): 2868 - 2870.
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