transparent gif


Ej inloggad.

Göteborgs universitets publikationer

Admission N-terminal pro-brain natriuretic peptide and its interaction with admission troponin T and ST segment resolution for early risk stratification in ST elevation myocardial infarction

Författare och institution:
E. Bjorklund (-); T. Jernberg (-); Per Johanson (Institutionen för medicin, avdelningen för akut och kardiovaskulär medicin); P. Venge (-); Mikael Dellborg (Institutionen för medicin, avdelningen för akut och kardiovaskulär medicin); L. Wallentin (-); B. Lindahl (-)
Publicerad i:
Heart, 92 ( 6 ) s. 735-40
1468-201X (Electronic)
Artikel, refereegranskad vetenskaplig
Sammanfattning (abstract):
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.
Ämne (baseras på Högskoleverkets indelning av forskningsämnen):
Aged, Female, Humans, Male, Middle Aged, Myocardial Infarction/*blood/mortality, Natriuretic Peptide, Brain/*blood, Patient Admission, Peptide Fragments/*blood, Prognosis, Regression Analysis, Risk Assessment, Sensitivity and Specificity, Survival Analysis, Troponin T/*blood
Postens nummer:
Posten skapad:
2007-10-23 13:18

Visa i Endnote-format

Göteborgs universitet • Tel. 031-786 0000
© Göteborgs universitet 2007