Copyright © 2004 by the European Society of Cardiology.
Clinical research
Relative value of N-terminal probrain natriuretic peptide, TIMI risk score, ACC/AHA prognostic classification and other risk markers in patients with non-ST-elevation acute coronary syndromes
a Department of Cardiology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
b Department of Cardiology, CEMIC, Buenos Aires, Argentina
c Department of Cardiology, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
d Department of Biochemistry, CEMIC, Buenos Aires, Argentina
* Corresponding author. Tel./fax: +54-11-4958-2623
E-mail address: oscar.bazzino{at}hospitaliano.org.ar
Received 1 October 2003; revised 24 February 2004; accepted 4 March 2004
Abstract
Aims We prospectively studied the additive value of N-terminal probrain natriuretic peptide (NT-proBNP) in relation to the Thrombolysis in Myocardial Infarction (TIMI) risk score and the American College of Cardiology/American Heart Association (ACC/AHA) joint prognostic classification, and compared the predictive capacity of NT-proBNP, troponin T (TnT), C-reactive protein (hsCRP), myoglobin, and creatine kinase-MB (CK-MB) concentrations in a cohort of 1483 consecutive patients with non-ST-segment-elevation acute coronary syndromes (NSTE-ACS).
Methods and results Centralised measurements of NT-proBNP, TnT, myoglobin, and hsCRP were performed 3 h (median) after admission.
Adjusting by clinical, ECG variables, and biomarkers, NT-proBNP concentration was the strongest independent predictor of in-hospital (OR 1.7, 95% CI: 1.31–2.20, 
) and 180-day mortality (OR 1.67, 95% CI: 1.41–1.99, ), and added significant prognostic information to the TIMI and ACC/AHA prognostic categories. NT-proBNP was not an independent predictor of risk of new myocardial infarction, even in the acute or long term.
Conclusions In NSTE-ACS, NT-proBNP adds substantial information to the TIMI risk score and the ACC/AHA classification. Compared to other biomarkers, NT-proBNP is the strongest independent predictor of in-hospital and 180-day mortality.
Key Words: N-terminal probrain natriuretic peptide • Acute coronary syndromes • Cardiac markers • Prognosis • Risk stratification
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