Ranjith N, Pegoraro R J, Naidoo D P, Esterhuizen T M
Department of Medicine, Coronary Care Unit, RK Khan Hospital, Durban, South Africa.
Cardiovasc J S Afr. 2006 Mar-Apr;17(2):60-6.
The aim of this study was to examine the prognostic value of admission N-terminal-pro-brain natriuretic peptide (NT-proBNP) measurements for the outcome of adverse events, and to compare it with that of cardiac troponin T in the assessment of risk in patients with acute coronary syndrome (ACS) during the hospital stay and at six months following hospital discharge.
The study population consisted of 200 Asian Indian patients admitted with a diagnosis of ACS to the Coronary Care Unit at RK Khan Hospital, Durban, South Africa. A reference group comprising 100 healthy Indian individuals drawn from the same community and who did not suffer from cardiovascular disease was also analysed.
The majority of patients presented with ST segment elevation myocardial infarction (STEMI) (71%), whereas 14.5% had non-ST segment elevation MI (NSTEMI), and the remaining 14.5% had unstable angina. Patients had multiple risk factors for coronary heart disease (CHD) including hypertension (59%), hypercholesterolaemia (59%), smoking (57%), diabetes mellitus (51%), obesity (46%), and a strong family history of CHD (55%). NT-proBNP levels were significantly increased in patients with STEMI (p = 0.005) and NSTEMI (p = 0.002) who developed adverse events during their hospital stay, compared with those who did not. At the six-month followup, although NT-proBNP levels were higher in patients with STEMI and NSTEMI who developed adverse events, these differences were not statistically significant. No differences in troponin T levels were detected in patients with STEMI and NSTEMI who developed adverse events, compared to those who did not, either during the hospital stay, or at six months after release. At hospital admission, 24% of patients with unstable angina who had elevated NT-proBNP levels and normal troponin T concentrations developed adverse events, compared to 38% at six months. NT-proBNP levels in the reference group were comparable with those reported in other populations.
This study demonstrated that elevation in admission NT-proBNP levels is an important determinant of acute and intermediate cardiac risk in patients with ACS. NT-proBNP concentrations were superior to those of troponin T as prognostic markers in both STEMI and NSTEMI. In a low-risk group of patients with unstable angina and negative troponin T concentrations, elevated NT-proBNP levels constituted a risk for the development of adverse cardiovascular events. Therefore, NT-proBNP should be included in the risk assessment of ACS to provide guidance for further therapeutic strategies.
本研究旨在探讨入院时N末端脑钠肽前体（NT-proBNP）测量值对不良事件结局的预后价值，并在评估急性冠状动脉综合征（ACS）患者住院期间及出院后6个月的风险时，将其与心肌肌钙蛋白T的预后价值进行比较。
研究人群包括200名被诊断为ACS并入住南非德班RK汗医院冠心病监护病房的亚洲印度患者。还分析了一个由100名来自同一社区且无心血管疾病的健康印度个体组成的参照组。
大多数患者表现为ST段抬高型心肌梗死（STEMI）（71%），而14.5%为非ST段抬高型心肌梗死（NSTEMI），其余14.5%为不稳定型心绞痛。患者有多种冠心病（CHD）危险因素，包括高血压（59%）、高胆固醇血症（59%）、吸烟（57%）、糖尿病（51%）、肥胖（46%）以及CHD家族史（55%）。与未发生不良事件的患者相比，住院期间发生不良事件的STEMI患者（p = 0.005）和NSTEMI患者（p = 0.002）的NT-proBNP水平显著升高。在6个月随访时，尽管发生不良事件的STEMI和NSTEMI患者的NT-proBNP水平较高，但这些差异无统计学意义。与未发生不良事件的患者相比，住院期间及出院后6个月，发生不良事件的STEMI和NSTEMI患者的肌钙蛋白T水平均未检测到差异。入院时，NT-proBNP水平升高且肌钙蛋白T浓度正常的不稳定型心绞痛患者中，24%发生了不良事件，6个月时这一比例为38%。参照组的NT-proBNP水平与其他人群报告的水平相当。
本研究表明，入院时NT-proBNP水平升高是ACS患者急性和中期心脏风险的重要决定因素。在STEMI和NSTEMI中，NT-proBNP浓度作为预后标志物优于肌钙蛋白T。在肌钙蛋白T浓度为阴性的低风险不稳定型心绞痛患者中，NT-proBNP水平升高构成心血管不良事件发生的风险。因此，NT-proBNP应纳入ACS的风险评估，为进一步的治疗策略提供指导。
