Department of Internal Medicine II (Cardiology), University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, Regensburg, 93053, Germany.
Department of Anesthesiology, Hospital Barmherzige Brüder Regensburg, Regensburg, Germany.
ESC Heart Fail. 2021 Jun;8(3):2293-2305. doi: 10.1002/ehf2.13332. Epub 2021 Apr 6.
The objective of this study was to investigate the prognostic value of urinary N-terminal pro-brain natriuretic peptide (NT-proBNP) compared with plasma NT-proBNP in patients presenting with acute chest pain in the emergency department.
We measured simultaneously plasma and urinary NT-proBNP at admission in 301 patients with acute chest pain. In our cohort, 174 patients suffered from acute coronary syndrome (ACS). A follow-up (median of 55 months) was performed regarding the endpoints all-cause mortality and major adverse cardiac events (mortality, congestive heart failure, ACS with the necessity of a coronary intervention, and stroke). Fifty-four patients died during follow-up; 98 suffered from the combined endpoint. A significant and positive correlation of urinary and plasma NT-proBNP was found (r = 0.87, P < 0.05). Patients with troponin positive ACS had significantly elevated levels of plasma and urinary NT-proBNP compared with those with unstable angina pectoris or chest wall syndrome (each P < 0.05). The highest levels of both biomarkers were found in patients with congestive heart failure (each P < 0.05). According to Kaplan-Meier analysis, plasma and urinary NT-proBNP were significant predictors for mortality and the combined endpoint in the whole study cohort and in the subgroup of patients with ACS (each P < 0.05). Regarding Cox regression analysis, plasma and urinary NT-proBNP were independent predictors for mortality and the combined endpoint (each P < 0.05).
Urinary NT-proBNP seems to provide a significant predictive value regarding the endpoints all-cause mortality and major adverse cardiac events in patients with acute chest pain and those with ACS.
本研究旨在探讨尿 N 末端脑利钠肽前体（NT-proBNP）与血浆 NT-proBNP 相比在急诊科急性胸痛患者中的预后价值。
我们同时测量了 301 例急性胸痛患者入院时的血浆和尿 NT-proBNP。在我们的队列中，174 例患者患有急性冠状动脉综合征（ACS）。对所有原因死亡率和主要不良心脏事件（死亡、充血性心力衰竭、需要冠状动脉介入治疗的 ACS 和中风）终点进行了中位时间为 55 个月的随访。在随访期间，54 例患者死亡，98 例患者发生了联合终点事件。尿和血浆 NT-proBNP 之间存在显著正相关（r=0.87，P<0.05）。与不稳定型心绞痛或胸壁综合征患者相比，肌钙蛋白阳性 ACS 患者的血浆和尿 NT-proBNP 水平显著升高（均 P<0.05）。两种生物标志物的水平均在充血性心力衰竭患者中最高（均 P<0.05）。根据 Kaplan-Meier 分析，血浆和尿 NT-proBNP 是整个研究队列和 ACS 患者亚组中死亡率和联合终点的显著预测因素（均 P<0.05）。Cox 回归分析显示，血浆和尿 NT-proBNP 是死亡率和联合终点的独立预测因素（均 P<0.05）。
尿 NT-proBNP 似乎对急性胸痛患者和 ACS 患者的全因死亡率和主要不良心脏事件终点具有显著的预测价值。
