Revista argentina de cardiología
versión On-line ISSN 1850-3748
ROLANDI, Florencia et al. NT-proBNP Predicts Clinical Outcomes in Patients with NSTE- ACS and Preserved Left Ventricular Function. Rev. argent. cardiol. [online]. 2006, vol.74, n.1, pp. 19-27. ISSN 1850-3748.
Background NT-proBNP levels are associated with left ventricular (LV) dysfunction and adverse outcome in non-ST-elevation acute coronary syndromes (NSTE-ACS). There is little evidence about the prognostic information of NT-proBNP in patients with normal LV function and NSTE-ACS. Work Objective To assess the prognostic value of NT-proBNP in patients with NSTE-ACS and without systolic dysfunction. Research Design and Methods From a cohort of patients with NSTE-ACS who underwent in-hospital angiography, we selected 393 who showed a left ventricular ejection fraction ≥40%. Independent core labs analyzed angiograms and NT-proBNP, troponin T, myoglobin and C-reactive protein measurements. Analyses were performed using a cut-off point of NT-proBNP of 586 pg/ml. The primary endpoint was incidence of death or myocardial infarction (MI) at 180 days. Results Eighty-three patients (21%) had NT-proBNP levels ≥586 pg/ ml, and 310 (79%) had NT-proBNP levels <586 pg/ml. Patients with increased NT-proBNP were older and more often females; they showed a higher proportion of elevated serum markers and a higher proportion of extended coronary disease and complex coronary lesions. Compared with those with NT-proBNP <586 pg/ml, these patients showed higher incidence of death (9.6% vs. 2.3%; p = 0.002), myocardial infarction (9.6% vs. 3.2%; p = 0.01), and death or MI (16.9% vs. 5.5%; p = 0.001) at 180 days. In a multivariate analysis including clinical, ECG and angiographic features, NT-proBNP was an independent predictor of total death and death /MI at 6 months. Conclusions NT-proBNP is an independent predictor of death or myocardial infarction and total death at 6 months in patients with NSTE-ACS and without systolic dysfunction.
Palabras llave : Natriuretic peptides; Myocardial ischemia; Prognosis.