Key result
In patients with suspected acute coronary syndrome, the highest quartile of B-type natriuretic peptide at admission was associated with a significantly increased risk of 2-year all-cause mortality (HR 2.32) compared to the lowest quartile.
Why the study?
Does measurement of BNP and hsCRP improve prediction of 2-year all-cause mortality in patients with chest pain and suspected ACS?
Observational (n=982)
Yes
Does measurement of BNP and hsCRP improve prediction of 2-year all-cause mortality in patients with chest pain and suspected ACS?
Hazard Ratio: 2.32 (95% CI 1.24–4.35)
p-value: p=0.009
Elevated admission levels of BNP and hsCRP are clinically useful biomarkers that independently predict 2-year all-cause mortality in patients presenting with chest pain and suspected ACS.
Admission BNP may refine mortality risk stratification in suspected ACS; observational data leave open whether testing alters management.
BACKGROUND: Several mechanisms are involved in the pathophysiology of the Acute Coronary Syndrome (ACS). We have addressed whether B-type natriuretic peptide (BNP) and high-sensitive C-reactive protein (hsCRP) in admission samples may improve risk stratification in chest pain patients with suspected ACS. METHODS: We included 982 patients consecutively admitted with chest pain and suspected ACS at nine hospitals in Salta, Northern Argentina. Total and cardiac mortality were recorded during a 2-year follow up period. Patients were divided into quartiles according to BNP and hsCRP levels, respectively, and inter quartile differences in mortality were statistically evaluated applying univariate and multivariate analyses. RESULTS: 119 patients died, and the BNP and hsCRP levels were significantly higher among these patients than in survivors. In a multivariable Cox regression model for total death and cardiac death in all patients, the hazard ratio (HR) in the highest quartile (Q4) as compared to the lowest quartile (Q1) of BNP was 2.32 (95% confidence interval (CI), 1.24-4.35), p = 0.009 and 3.34 (95% CI, 1.26-8.85), p = 0.015, respectively. In the TnT positive patients (TnT > 0.01 ng/mL), the HR for total death and cardiac death in Q4 as compared to Q1 was 2.12 (95% CI, 1.07-4.18), p = 0.031 and 3.42 (95% CI, 1.13-10.32), p = 0.029, respectively.The HR for total death for hsCRP in Q4 as compared to Q1 was 1.97 (95% CI, 1.17-3.32), p = 0.011, but this biomarker did not predict cardiac death (p = 0.21). No prognostic impact of these two biomarkers was found in the TnT negative patients. CONCLUSION: BNP and hsCRP may act as clinically useful biomarkers when obtained at admission in a population with suspected ACS.
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Fuente et al. (2011) conducted an observational in Chest pain with suspected Acute Coronary Syndrome (ACS) (n=982). Highest quartile of B-type natriuretic peptide (BNP) vs. Lowest quartile of BNP was evaluated on All-cause mortality at 2 years (HR 2.32, 95% CI 1.24-4.35, p=0.009). In patients with suspected acute coronary syndrome, the highest quartile of B-type natriuretic peptide at admission was associated with a significantly increased risk of 2-year all-cause mortality (HR 2.32) compared to the lowest quartile.
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