Liu Wen-xian, Zhao Han
Department of Cardiology, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2012 May;40(5):373-7.
To explore the relationship between plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) level obtained on admission and global registry of acute coronary events (GRACE) scores and the value for risk stratification in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS).
A total of 231 NSTE-ACS patients admitted in our hospital between June 2009 and September 2010 were included [161 patients with unstable angina (UA) and 70 patients with non-ST-segment elevation myocardial infarction (NSTEMI)]. On admission plasma NT-proBNP was measured in all patients. The GRACE risk score were used for risk assessment. Patients were followed up for 6 months and incidence of new or recurrent myocardial infarction, target vessel revascularization, cardiac death, heart failure (MACE) was recorded.
According to GRACE risk stratification, there were 62 low-risk patients, 78 middle-risk patients and 91 high-risk patients. lgNT-proBNP level on admission increased in proportion to increasing risk defined by GRACE risk stratification and lgNT-proBNP positively correlated with GRACE risk score (r = 0.59, P < 0.001). The GRACE risk score was the highest in the fourth NT-proBNP quartile (P < 0.001 vs. lowest, second and third quartiles). GRACE score was significantly higher in patients with NT-proBNP level above the 75 percentile compared patients with NT-proBNP under the 75 percentile (P < 0.001). MACE occurred in 9 [3.9% (9/231)] patients during follow up. ROC analysis showed AUC of on admission NT-proBNP was 0.831 (SE = 0.062, P = 0.001, 95%CI 0.711 - 0.952) and AUC of GRACE risk score was 0.799 (SE = 0.079, P = 0.002, 95%CI 0.644 - 0.954) for predicting the short-term risk of MACE (P = 0.75).
On admission plasma NT-proBNP level parallels GRACE risk score in NSTE-ACS patients, both on admission plasma NT-proBNP level and GRACE risk score are valuable parameters for risk stratification in patients with NSTE-ACS and increased NT-proBNP level and GRACE values are predictors for increased short-term risk of MACE.
探讨非ST段抬高型急性冠状动脉综合征（NSTE-ACS）患者入院时血浆N末端脑钠肽前体（NT-proBNP）水平与全球急性冠状动脉事件注册（GRACE）评分之间的关系及其在风险分层中的价值。
纳入2009年6月至2010年9月在我院住院的231例NSTE-ACS患者[161例不稳定型心绞痛（UA）患者和70例非ST段抬高型心肌梗死（NSTEMI）患者]。所有患者入院时均检测血浆NT-proBNP。采用GRACE风险评分进行风险评估。对患者进行6个月的随访，记录新发或复发性心肌梗死、靶血管血运重建、心源性死亡、心力衰竭（MACE）的发生率。
根据GRACE风险分层，低危患者62例，中危患者78例，高危患者91例。入院时lgNT-proBNP水平随GRACE风险分层定义的风险增加而升高，lgNT-proBNP与GRACE风险评分呈正相关（r = 0.59，P < 0.001）。GRACE风险评分在NT-proBNP第四四分位数中最高（与最低、第二和第三四分位数相比，P < 0.001）。NT-proBNP水平高于第75百分位数的患者的GRACE评分显著高于NT-proBNP水平低于第75百分位数的患者（P < 0.001）。随访期间9例[3.9%（9/231）]患者发生MACE。ROC分析显示，入院时NT-proBNP预测MACE短期风险的AUC为0.831（SE = 0.062，P = 0.001，95%CI 0.711 - 0.952），GRACE风险评分的AUC为0.799（SE = 0.079，P = 0.002，95%CI 0.644 - 0.954）（P = 0.75）。
NSTE-ACS患者入院时血浆NT-proBNP水平与GRACE风险评分平行，入院时血浆NT-proBNP水平和GRACE风险评分均是NSTE-ACS患者风险分层的有价值参数，NT-proBNP水平升高和GRACE值升高是MACE短期风险增加的预测指标。
