Omland Torbjørn, Persson Anita, Ng Leong, O'Brien Russel, Karlsson Thomas, Herlitz Johan, Hartford Marianne, Caidahl Kenneth
Department of Cardiology, National Hospital, Oslo, Norway.
Circulation. 2002 Dec 3;106(23):2913-8. doi: 10.1161/01.cir.0000041661.63285.ae.
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.
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]).
N-BNP is a powerful indicator of long-term mortality in patients with ACS and provides prognostic information above and beyond conventional risk markers.
B型利钠肽（BNP）是急性冠脉综合征（ACS）全谱中短期和中期预后的预测指标。BNP前体激素的N端片段，即N-BNP，可能是更强的预后标志物。我们在一个大型当代ACS患者队列中评估了亚急性期血浆N-BNP水平与长期全因死亡率之间的关系。
在亚急性期获取了204例ST段抬高型心肌梗死（MI）患者、220例非ST段抬高型MI患者和185例不稳定型心绞痛患者的血样用于测定N-BNP。中位随访51个月后，86例患者（14%）死亡。长期存活者的中位N-BNP水平显著低于死亡患者（442对1306 pmol/L；P<0.0001）。N-BNP水平高于中位数的患者未经调整的风险比为3.9（95%置信区间，2.4至6.5）。在多变量Cox回归模型中，N-BNP（风险比2.1 [95%置信区间，1.1至3.9]）在Killip分级、患者年龄和左心室射血分数之外增加了预后信息。对肌钙蛋白T峰值水平进行调整并未显著改变N-BNP与死亡率之间的关系。在无临床心力衰竭证据的患者中，调整年龄和射血分数后，N-BNP仍然是死亡率的显著预测指标（风险比，2.4 [95%置信区间，1.1至5.4]）。
N-BNP是ACS患者长期死亡率的有力指标，并提供了超越传统风险标志物的预后信息。
