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European Heart Journal Advance Access originally published online on December 1, 2004
European Heart Journal 2005 26(3):234-240; doi:10.1093/eurheartj/ehi033
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European Heart Journal vol. 26 no. 3 © The European Society of Cardiology 2004; all rights reserved.

B-type natriuretic peptide: a novel early blood marker of acute myocardial infarction in patients with chest pain and no ST-segment elevation

Roberto Bassan1,*, Alfredo Potsch2, Alan Maisel3, Bernardo Tura2, Humberto Villacorta2, Mônica Viegas Nogueira2, Augusta Campos2, Roberto Gamarski2, Antonio Cláudio Masetto2 and Marco Aurélio Moutinho2

1Clinica São Vicente, R. João Borges 204, Rio de Janeiro 22.451-100, Brazil
2Pró-Cardíaco Hospital, Rio de Janeiro, Brazil
3Coronary Care Unit, VA San Diego Health Care System, CA, USA

Received 13 May 2004; revised 24 September 2004; accepted 30 September 2004; online publish-ahead-of-print 1 December 2004.

* Corresponding author. Tel: +55 21 2529 4611; fax: +55 21 2529 4554. E-mail address: rbassan{at}domain.com.br

See page 207 for the editorial comment on this article (doi:10.1093/eurheartj/ehi078)

Aims This study was undertaken to determine the diagnostic value of admission B-type natriuretic peptide (BNP) for acute myocardial infarction (AMI) in patients with acute chest pain and no ST-segment elevation.

Methods and results A prospective study with 631 consecutive patients was conducted in the emergency department. Non-ST elevation AMI was present in 72 patients and their median admission BNP level was significantly higher than in unstable angina and non-acute coronary syndrome patients. Sensitivity of admission BNP for AMI (cut-off value of 100 pg/mL) was significantly higher than creatine kinase-MB (CKMB) and troponin-I on admission (70.8 vs. 45.8 vs. 50.7%, respectively, P<0.0001) and specificity was 68.9%. Simultaneous use of these markers significantly improved sensitivity to 87.3% and the negative predictive value to 97.3%. In multiple logistic regression analysis, admission BNP was a significant independent predictor of AMI, even when CKMB and troponin-I were present in the model.

Conclusion BNP is a useful adjunct to standard cardiac markers in patients presenting to the emergency department with chest pain and no ST-segment elevation, particularly if initial CKMB and/or troponin-I are non-diagnostic.

Key Words: Acute coronary syndrome • Acute myocardial infarction • Natriuretic peptide


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