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European Heart Journal Advance Access published online on December 20, 2004
European Heart Journal, doi:10.1093/eurheartj/ehi038
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European Heart Journal © The European Society of Cardiology 2004; all rights reserved

Clinical research

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 Jarai 1, Nelly Iordanova 2, Robert Jarai 3, Annamaria Raffetseder 4, Wolfgang Woloszczuk 4, Mariann Gyöngyösi 5, Georg Geyer 4, Johann Wojta 5, and Kurt Huber 1*

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

* To whom correspondence should be addressed.
Kurt Huber, E-mail: kurt.huber{at}univie.ac.at


  Abstract

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.

Keywords: Atrial natriuretic peptide; Brain natriuretic peptide; Troponin I; Acute coronary syndromes; Risk prediction.
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