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European Heart Journal Advance Access originally published online on December 20, 2004
European Heart Journal 2005 26(3):250-256; doi:10.1093/eurheartj/ehi038
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European Heart Journal vol. 26 no. 3 © The European Society of Cardiology 2004; all rights reserved.

Risk assessment in patients with unstable angina/non-ST-elevation myocardial infarction and normal N-terminal pro-brain natriuretic peptide levels by N-terminal pro-atrial natriuretic peptide

Rudolf Jarai1,2, Nelly Iordanova1, Robert Jarai3, Annamaria Raffetseder4, Wolfgang Woloszczuk4, Mariann Gyöngyösi2, Georg Geyer4, Johann Wojta2 and Kurt Huber1,2,*

1Third Department of Medicine (Cardiology and Emergency Medicine), Wilhelminen Hospital Vienna, Montleartstrasse 37, A-1171 Vienna, Austria
2Department of Cardiology, University of Vienna, Vienna, Austria
3Department of Psychology, University of Pecs, Pecs, Hungary
4Ludwig-Boltzmann Institute of Experimental Endocrinology, Vienna, Austria

Received 21 November 2003; revised 15 September 2004; accepted 5 October 2004; online publish-ahead-of-print 20 December 2004.

* Corresponding author. Tel: +43 1 49150 2301; fax: +43 1 49150 2309. E-mail address: kurt.huber{at}univie.ac.at

Aims To compare the accuracy of the N-terminal fragment of its pro-hormone (Nt-proBNP) and N-terminal pro-atrial natriuretic peptide (Nt-proANP) in the prediction of the 2 year mortality and to investigate whether additional measurement of Nt-proANP to troponin I (TnI) could improve risk assessment in the subgroups of patients with unstable coronary artery disease (UCAD) and normal Nt-proBNP.

Methods and results Plasma levels of the TnI, Nt-proANP, and Nt-proBNP were determined in 120 consecutive patients with UCAD without ST-segment elevations and normal left ventricular function. In multivariable logistic regression analysis, TnI and Nt-proBNP were independent predictors of mortality (P=0.01 and P=0.02, respectively). However, in the group of patients with normal Nt-proBNP levels, only Nt-proANP and TnI were independently associated with mortality (P=0.007 and P=0.03, respectively). Accordingly, patients with elevated Nt-proANP levels in this group of patients had significantly higher mortality rate than patients with normal Nt-proANP levels (P=0.003).

Conclusion Our results suggest that determination of Nt-proANP might improve risk assessment in patients with UCAD, especially when Nt-proBNP is in the normal range.

Key Words: Atrial natriuretic peptide • Brain natriuretic peptide • Troponin I • Acute coronary syndromes • Risk prediction


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