Correlation of B-type natriuretic peptide and electrocardiographic alteration at presentation and prognosis in patients with non-ST-segment elevation myocardial infarction

Background

Elevated levels of B-type natriuretic peptide (BNP) drawn at presentation and concomitant cardiac troponin I (cTnI) after coronary heart disease associated with electrocardiographic alterations for high mortality. Sparse data are available on its use at first presentation with non-ST-segment elevation myocardial infarction (NSTEMI).

Objectives

We sought to evaluate BNP, alone and in comparison with cTnI and electrocardiography alterations, for risk assessment at initial presentation NSTEMI.

Methods

We obtained samples from 50 patients presenting within 6 hours of NSTEMI admission to our coronary unit care with electrocardiography alterations, and measured BNP/troponin I at 0 hours and 6–12 hours after admission. All patients underwent coronary angiography for treatment of NSTEMI.

Results

Of 50 patients, 42 were men. The mean age was 67.3 years. The median BNP was higher in patients who died (89 pg/ml, 25th–75th percentile: 40–192), compared with survivors (15 pg/ml, 25th–75th percentile: 8.8–32, P < 0.0001). Patients with BNP >80 pg/ml were at significantly higher risk of death (17.4% vs 1.8%, P < 0.0001). Cardiac troponin established a gradient of mortality between the highest and lowest quartile (7.9% vs 0%, P = 0.007). Patients with BNP >80 pg/ml were also more likely to have impaired coronary flow (P = 0.049) and more electrocardiography alterations of the ST segment (P = 0.05).

Conclusions

Increased concentrations of BNP at initial presentation of patients with NSTEMI are associated with electrocardiography alterations and cTnI impaired reperfusion after coronary angiography and higher short-term risk of mortality. These data support the value of combining markers of hemodynamic stress with traditional approaches to risk assessment in non-ST elevation of myocardial infarction.