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Dynamic changes in N-terminal pro-brain natriuretic peptide in acute coronary syndromes treated with percutaneous coronary intervention: a marker of ischemic burden, reperfusion and outcome

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Published/Copyright: May 4, 2010
Clinical Chemistry and Laboratory Medicine
From the journal Clinical Chemistry and Laboratory Medicine Volume 48 Issue 6

Abstract

Background: Whereas N-terminal pro-brain natriuretic peptide (NT-proBNP) is approved for risk stratification of patients with acute coronary syndromes (ACS), short-term temporal changes in NT-proBNP concentrations and the optimal time points for sampling are not clear. The purpose of this study was to better define the short-term changes in NT-proBNP in relation to clinical presentation, reperfusion and prognostic value in patients with ACS, as well as to identify the optimum time points for sampling.

Methods: We studied daily plasma concentrations of NT-proBNP in 133 unselected patients with myocardial infarction (n=65), stable coronary artery disease (CAD, n=46) and no CAD (n=22) who underwent coronary angiography.

Results: Patients with non-ST-elevation myocardial infarction (NSTEMI) presented with markedly higher NT-proBNP than patients with ST-elevation myocardial infarction (STEMI) [1305 (741–3208) ng/L vs. 170 (70–424) ng/L, p<0.001]. Also, time to presentation from onset of pain was much longer in NSTEMI as compared to STEMI (>48 h vs. <6 h, p<0.001). Patients with NSTEMI also presented with higher NT-proBNP as compared with CAD [224 (98–732) ng/L] and no CAD [47 (26–102) ng/L; p<0.001, NSTEMI vs. both]. Following successful percutaneous coronary intervention [thrombolysis in myocardial infarction (TIMI) 3-flow established], NT-proBNP increased markedly within 24 h in patients with STEMI [718 (379–1338) ng/L, p<0.01 vs. 0 h], whereas no change in NT-proBNP was noted in patients with NSTEMI [1190 (1010–2024) ng/L, p=0.88 vs. 0 h]. In both STEMI and NSTEMI, NT-proBNP decreased significantly 96 h after successful reperfusion [STEMI –52%, 372 (189–610) ng/L, p<0.05; NSTEMI –52%, 613 (365–724) ng/L, p<0.05]. Unsuccessful reperfusion (TIMI<3) was associated with unchanged or increased NT-proBNP. NT-proBNP at 96 h and peak NT-proBNP further displayed a strong correlation with cardiac troponin T (r=0.64 and r=0.54, p<0.001), a marker of infarct size, and NT-proBNP at 96 h was a strong predictor of long-term prognosis (hazard ratio 7.29, p=0.025).

Conclusions: In patients with NSTEMI, NT-proBNP may be increased as high as concentrations usually associated with acute congestive heart failure despite the absence of clinical signs. In contrast, patients with STEMI and short time to presentation may present with completely normal NT-proBNP, but dramatic short-term increases following reperfusion. NT-proBNP reflects ischemic burden, reperfusion success and prognosis, and the current data support repetitive sampling in patients with ACS.

Clin Chem Lab Med 2010;48:875–81.

Keywords: acute coronary syndromes; natriuretic peptide; N-terminal pro-brain natriuretic peptide; prognosis; serial changes
Corresponding author: Prof. Dr. med. Andreas Luchner, Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93042 Regensburg, Germany Phone: +49 941 944 7211, Fax: +49 941 944 7213,
Received: 2009-9-23
Accepted: 2010-1-27
Published Online: 2010-05-4
Published in Print: 2010-06-01

©2010 by Walter de Gruyter Berlin New York

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https://doi.org/10.1515/CCLM.2010.164
Keywords for this article
acute coronary syndromes; natriuretic peptide; N-terminal pro-brain natriuretic peptide; prognosis; serial changes

Articles in the same Issue

  1. Editorials
  2. The “Obamanomics”: a revolution in laboratory diagnostics
  3. Skeletal muscle biomarkers: not new but still interesting diagnostic tools
  4. Necessity for high-quality reference materials in the harmonization of laboratory assays
  5. Reviews
  6. Rhabdomyolysis: historical background, clinical, diagnostic and therapeutic features
  7. Biochemical markers of muscular damage
  8. Minireview
  9. Interpretation of serum parathyroid hormone concentrations in dialysis patients: what do the KDIGO guidelines change for the clinical laboratory?
  10. Guidelines and Recommendations
  11. 2010 Consensus statement on the worldwide standardization of the hemoglobin A1c measurement
  12. Genetics and Molecular Diagnostics
  13. Development of a low-cost real-time reverse transcriptase-polymerase chain reaction technique for the detection and quantification of hepatitis C viral load
  14. Microsatellite polymorphisms in intron 2 of the toll-like receptor 2 gene and their association with susceptibility to pulmonary tuberculosis in Han Chinese
  15. Evaluation of a panel of circulating DNA, RNA and protein potential markers for pathologies of pregnancy
  16. General Clinical Chemistry and Laboratory Medicine
  17. Traceability of values for catalytic activity concentration of enzymes: a Certified Reference Material for aspartate transaminase
  18. Development and preparation of a new serum protein reference material: feasibility studies and processing
  19. A WHO Reference Reagent for the Serum Transferrin Receptor (sTfR): international collaborative study to evaluate a recombinant soluble transferrin receptor preparation
  20. Hyperhomocysteinemia is not associated with reduced bone quality in humans with hip osteoarthritis
  21. Diagnostic performance of anti-citrullinated peptide antibodies for the diagnosis of rheumatoid arthritis: the relevance of likelihood ratios
  22. New quantitative electrochemiluminescence method (ECLIA) for interleukin-6 (IL-6) measurement
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  36. Neuropharmacology of schizophrenia: is there a role for leptin?
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