Sheng-Yong Dong1, Mao-Sheng Dong, Zhi-Heng Chen, Jing Sun, Xue Yang, Qiang Zeng. 1. International Medical Center (S-YD, JS, QZ), Chinese PLA General Hospital, Beijing, China; Hangzhou Sanatorium of Nanjing Military District (M-SD), Hangzhou, Zhejiang Province, China; Health Care Department (XY), Chinese PLA General Hospital, Beijing, China; Health Management Center (Z-HC), The Third Xiangya Hospital of Central South University, Changsha, Hunan Province, China.
Abstract
BACKGROUND: Very few studies have evaluated the potential of using B-type natriuretic peptide (BNP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) as surrogate markers to guide clinical interventional or conservative therapy decisions. AIM: : The aim of the current study was to evaluate the potential of using BNP and NT-proBNP as surrogate markers to guide clinical interventional or conservative therapy decisions. METHODS: We identified randomized controlled trials that randomized patients with acute coronary syndrome (ACS) of unstable angina and myocardial infarction without ST-segment elevation ACS to early invasive therapy versus a more conservative approach by systematic search of articles and databases. RESULTS: Five randomized controlled trials with a total of 8125 patients and with a mean duration of 11.2 months were included in the meta-analysis. At a mean follow-up of 11.2 months, the incidence of all-cause mortality was 5.9% in the early invasive group, compared with 6.8% in the conservative group (risk ratio = 0.74; 95% confidence interval, 0.59-0.86; P = 0.001). CONCLUSIONS: In summary, BNP/NT-proBNP-guided management of ACS is significantly improved by early invasive therapy by improving long-term survival and reducing nonfatal myocardial infarction for unstable angina. However, there does not seem to be a clear benefit of using such a strategy over existing clinical recommendations.
BACKGROUND: Very few studies have evaluated the potential of using B-type natriuretic peptide (BNP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) as surrogate markers to guide clinical interventional or conservative therapy decisions. AIM: : The aim of the current study was to evaluate the potential of using BNP and NT-proBNP as surrogate markers to guide clinical interventional or conservative therapy decisions. METHODS: We identified randomized controlled trials that randomized patients with acute coronary syndrome (ACS) of unstable angina and myocardial infarction without ST-segment elevation ACS to early invasive therapy versus a more conservative approach by systematic search of articles and databases. RESULTS: Five randomized controlled trials with a total of 8125 patients and with a mean duration of 11.2 months were included in the meta-analysis. At a mean follow-up of 11.2 months, the incidence of all-cause mortality was 5.9% in the early invasive group, compared with 6.8% in the conservative group (risk ratio = 0.74; 95% confidence interval, 0.59-0.86; P = 0.001). CONCLUSIONS: In summary, BNP/NT-proBNP-guided management of ACS is significantly improved by early invasive therapy by improving long-term survival and reducing nonfatal myocardial infarction for unstable angina. However, there does not seem to be a clear benefit of using such a strategy over existing clinical recommendations.
Authors: Julie McLellan; Carl J Heneghan; Rafael Perera; Alison M Clements; Paul P Glasziou; Karen E Kearley; Nicola Pidduck; Nia W Roberts; Sally Tyndel; F Lucy Wright; Clare Bankhead Journal: Cochrane Database Syst Rev Date: 2016-12-22