Do raised serum N-terminal pro-BNP and low creatinine clearance predict mortality and MI in patients with non-ST-segment-elevation acute coronary syndromes?
Renal impairment combined with elevated BNP strongly predicts mortality and myocardial infarction in patients with non-ST-segment-elevation acute coronary syndromes.
In a recent GUSTO-IV substudy of 6809 patients with non-ST-segment-elevation acute coronary syndromes, raised serum N-terminal pro-brain natriuretic peptide (BNP) and creatinine clearance below the 25th percentile (51 mL/min) independently predicted 1-year mortality. 1 The combination of creatinine clearance with BNP was the strongest predictor of death, compared with each marker alone, or to the combination of BNP with troponin T, C-reactive protein, or heart rate. Strikingly, creatinine clearance 51 mL/min, but not raised BNP, also predicted myocardial infarction (MI) at 30 days. Unexpectedly, however, the authors did not discuss the association of renal impairment with incident death and MI.
Andreotti et al. (2004) studied this question.