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European Heart Journal Advance Access published online on December 1, 2004
European Heart Journal, doi:10.1093/eurheartj/ehi033
Copyright © 2004 by the European Society of Cardiology.
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Clinical research

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

Roberto Bassan 1*, Alfredo Potsch 2, Alan Maisel 3, Bernardo Tura 2, Humberto Villacorta 2, Mônica Viegas Nogueira 2, Augusta Campos 2, Roberto Gamarski 2, Antonio Cláudio Masetto 2, and Marco Aurélio Moutinho 2

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

* To whom correspondence should be addressed.
Roberto Bassan, E-mail: rbassan{at}domain.com.br


  Abstract

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 100pg/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.

Keywords: Acute coronary syndrome; Acute myocardial infarction; Natriuretic peptide.
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