Availability of Bedside N-terminal Pro-Brain Natriuretic Peptide Measurement as Prognostic Marker About Development of Major Adverse Cardiovascular Events in Patients of Acute Coronary Syndromes

Kim,  Hye Jin; Park,  Jun Seok; Kim,  Ah Jin; Roh,  Jun Young; Kim,  Kyung Hwan; Shin,  Dong Wun

J Korean Soc Emerg Med > Volume 19(1); 2008 > Article

Original Article

Journal of The Korean Society of Emergency Medicine 2008;19(1): 65-73.

Availability of Bedside N-terminal Pro-Brain Natriuretic Peptide Measurement as Prognostic Marker About Development of Major Adverse Cardiovascular Events in Patients of Acute Coronary Syndromes

Hye Jin Kim, Jun Seok Park, Ah Jin Kim, Jun Young Roh, Kyung Hwan Kim, Dong Wun Shin

Department of Emergency Medicine, Inje University Ilsan Paik Hospital, Gyeonggi-Do, Korea. dwshin@ilsanpaik.ac.kr

ABSTRACT

PURPOSE:
Natriuretic peptide levels are known to be associated with cardiac output and ventricular function. Recently it has been suggested that N-terminal pro-brain natriuretic peptide (NT-pro-BNP) is available as a prognostic marker for acute coronary syndrome patients. We compared NTpro- BNP levels between patients with and without major adverse cardiovascular events (MACEs) who visited the emergency room due to acute coronary syndrome.
METHODS:
We designed a case-only study with study subjects recruited retrospectively by medical chart review. Patients who visited the emergency room from 1 May 2006 to 31 February 2007 and were diagnosed with acute coronary syndrome were enrolled. Subjects who did not receive bedside measurement of NT-proBNP levels were excluded. To analyze by subtype of acute coronary syndrome, we classified study subjects into the following group: ST elevation myocardial infarction, non-ST elevation myocardial infarction, or unstable angina.
RESULTS:
The level of NT-proBNP was 2,592+/-917 pg/ml in MACEs patients, and 1,289+/-1,261 pg/ml in patients without MACEs, a statistically significant difference (p<0.0001). The MACEs patients showed higher level of NT-proBNP than patients without MACEs in the ST elevation myocardial infarction group (p=0.439), the non-ST elevation myocardial infarction group (p=0.004), and the unstable angina group (p=0.009).
CONCLUSION:
Initial bedside NT-pro-BNP levels are higher in MACEs patients. Although the study size was small and the result should be carefully interpreted, it supports the hypothesis that NT-pro-BNP can as a marker to evaluate MACEs in acute coronary syndrome.

Key words: Pro-brain natriuretic peptide, Complications, Biologic markers