OBJECTIVE: To assess the long term prognostic value of N-terminal pro-brain natriuretic peptide (NT-proBNP) on admission and its prognostic interaction with both admission troponin T (TnT) concentrations and resolution of ST segment elevation in fibrinolytic treated ST elevation myocardial infarction (STEMI). DESIGN AND SETTING: Substudy of the ASSENT (assessment of the safety and efficacy of a new thrombolytic) -2 and ASSENT-PLUS trials. PATIENTS: NT-proBNP and TnT concentrations were determined on admission in 782 patients. According to NT-proBNP concentrations, patients were divided into three groups: normal concentration (for patients < or = 65 years, < or = 184 ng/l and < or = 268 ng/l and for those > 65 years, < or = 269 ng/l and < or = 391 ng/l in men and women, respectively); higher than normal but less than the median concentration (742 ng/l); and above the median concentration. For TnT, a cut off of 0.1 microg/l was used. Of the 782 patients, 456 had ST segment resolution (< 50% or > or = 50%) at 60 minutes calculated from ST monitoring. MAIN OUTCOME MEASURES: All cause one year mortality. RESULTS: One year mortality increased stepwise according to increasing concentrations of NT-proBNP (3.4%, 6.5%, and 23.5%, respectively, p < 0.001). In receiver operating characteristic analysis, NT-proBNP strongly trended to be associated more with mortality than TnT and time to 50% ST resolution (area under the curve 0.81, 95% confidence interval (CI) 0.72 to 0.9, 0.67, 95% CI 0.56 to 0.79, and 0.66, 95% CI 0.56 to 0.77, respectively). In a multivariable analysis adjusted for baseline risk factors and TnT, both raised NT-proBNP and ST resolution < 50% were independently associated with higher one year mortality, whereas raised TnT contributed independently only before information on ST resolution was added to the model. CONCLUSION: Admission NT-proBNP is a strong independent predictor of mortality and gives, together with 50% ST resolution at 60 minutes, important prognostic information even after adjustment for TnT and baseline characteristics in STEMI.
OBJECTIVE: To assess the long term prognostic value of N-terminal pro-brain natriuretic peptide (NT-proBNP) on admission and its prognostic interaction with both admission troponin T (TnT) concentrations and resolution of ST segment elevation in fibrinolytic treated ST elevation myocardial infarction (STEMI). DESIGN AND SETTING: Substudy of the ASSENT (assessment of the safety and efficacy of a new thrombolytic) -2 and ASSENT-PLUS trials. PATIENTS: NT-proBNP and TnT concentrations were determined on admission in 782 patients. According to NT-proBNP concentrations, patients were divided into three groups: normal concentration (for patients < or = 65 years, < or = 184 ng/l and < or = 268 ng/l and for those > 65 years, < or = 269 ng/l and < or = 391 ng/l in men and women, respectively); higher than normal but less than the median concentration (742 ng/l); and above the median concentration. For TnT, a cut off of 0.1 microg/l was used. Of the 782 patients, 456 had ST segment resolution (< 50% or > or = 50%) at 60 minutes calculated from ST monitoring. MAIN OUTCOME MEASURES: All cause one year mortality. RESULTS: One year mortality increased stepwise according to increasing concentrations of NT-proBNP (3.4%, 6.5%, and 23.5%, respectively, p < 0.001). In receiver operating characteristic analysis, NT-proBNP strongly trended to be associated more with mortality than TnT and time to 50% ST resolution (area under the curve 0.81, 95% confidence interval (CI) 0.72 to 0.9, 0.67, 95% CI 0.56 to 0.79, and 0.66, 95% CI 0.56 to 0.77, respectively). In a multivariable analysis adjusted for baseline risk factors and TnT, both raised NT-proBNP and ST resolution < 50% were independently associated with higher one year mortality, whereas raised TnT contributed independently only before information on ST resolution was added to the model. CONCLUSION: Admission NT-proBNP is a strong independent predictor of mortality and gives, together with 50% ST resolution at 60 minutes, important prognostic information even after adjustment for TnT and baseline characteristics in STEMI.
Authors: F Van De Werf; J Adgey; D Ardissino; P W Armstrong; P Aylward; G Barbash; A Betriu; A S Binbrek; R Califf; R Diaz; R Fanebust; K Fox; C Granger; J Heikkilä; S Husted; P Jansky; A Langer; E Lupi; A Maseri; J Meyer; J Mlczoch; D Mocceti; D Myburgh; A Oto; E Paolasso; K Pehrsson; R Seabra-Gomes; L Soares-Piegas; D Sùgrue; M Tendera; E Topol; P Toutouzas; A Vahanian; F Verheugt; L Wallentin; H White Journal: Lancet Date: 1999-08-28 Impact factor: 79.321
Authors: T Omland; A Aakvaag; V V Bonarjee; K Caidahl; R T Lie; D W Nilsen; J A Sundsfjord; K Dickstein Journal: Circulation Date: 1996-06-01 Impact factor: 29.690
Authors: Jessica L Mega; David A Morrow; James A De Lemos; Marc S Sabatine; Sabina A Murphy; Nader Rifai; C Michael Gibson; Elliott M Antman; Eugene Braunwald Journal: J Am Coll Cardiol Date: 2004-07-21 Impact factor: 24.094
Authors: E Morita; H Yasue; M Yoshimura; H Ogawa; M Jougasaki; T Matsumura; M Mukoyama; K Nakao Journal: Circulation Date: 1993-07 Impact factor: 29.690
Authors: K L Lee; L H Woodlief; E J Topol; W D Weaver; A Betriu; J Col; M Simoons; P Aylward; F Van de Werf; R M Califf Journal: Circulation Date: 1995-03-15 Impact factor: 29.690
Authors: Daniel Lindholm; Stefan K James; Katja Gabrysch; Robert F Storey; Anders Himmelmann; Christopher P Cannon; Kenneth W Mahaffey; Philippe Gabriel Steg; Claes Held; Agneta Siegbahn; Lars Wallentin Journal: JAMA Cardiol Date: 2018-12-01 Impact factor: 14.676
Authors: Jay S Shavadia; Christopher B Granger; Wendimagegn Alemayehu; Cynthia M Westerhout; Thomas J Povsic; Sean Van Diepen; Christopher Defilippi; Paul W Armstrong Journal: J Am Heart Assoc Date: 2020-06-17 Impact factor: 5.501
Authors: Mathijs C Bodde; Maaike P J Hermans; Arnoud van der Laarse; Bart Mertens; Fred P H T M Romijn; Martin J Schalij; Christa M Cobbaert; J Wouter Jukema Journal: Cardiol Ther Date: 2019-01-30