N-terminal pro-brain natriuretic peptide in relation to inflammation, myocardial necrosis, and the effect of an invasive strategy in unstable coronary artery disease

被引:130
|
作者
Jernberg, T
Lindahl, B
Siegbahn, A
Andren, B
Frostfeldt, G
Lagerqvist, B
Stridsberg, M
Venge, P
Wallentin, L
机构
[1] Univ Uppsala Hosp, Dept Med Sci, Uppsala, Sweden
[2] Univ Uppsala Hosp, Ctr Cardiothorac, Uppsala, Sweden
[3] Univ Uppsala Hosp, Uppsala Clin Res Inst, Uppsala, Sweden
关键词
D O I
10.1016/j.jacc.2003.07.015
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
OBJECTIVES We sought to examine whether measurements of N-terminal pro-brain natriuretic peptide (NT-proBNP), in addition to cardiac troponin T (cTnT) and interleukin-6 (IL-6), improve the ability to identify high-risk patients who benefit from an early invasive strategy. BACKGROUND Biochemical indicators of cardiac performance (e.g., NT-proBNP), inflammation (e.g., IL-6), and myocardial damage (e.g., cTnT) predict mortality in unstable coronary artery disease (UCAD) (i.e., unstable angina or non-ST-segment elevation myocardial infarction [MI]). In these patients, an early invasive treatment strategy improves the outcome. METHODS Levels of NT-proBNP, cTnT, and IL-6 were measured in 2,019 patients with UCAD randomized to an invasive or non-invasive strategy in the FRagmin and fast revascularization during InStabitity in Coronary artery disease (FRISC-II) trial. Patients were followed up for two years to determine death and MI. RESULTS Patients in the third NT-proBNP tertile had a 4.1-fold (95% confidence interval [CI] 2.4 to 7.2) and 3.5-fold (95% CI 1.8 to 6.8) increased mortality in the non-invasive and invasive groups, respectively. An increased NT-proBNP level was independently associated with mortality. In patients with increased levels of both NT-proBNP and IL-6, an early invasive strategy reduced mortality by 7.3% (risk ratio 0.46, 95% CI 0.21 to 1.00). In patients with lower NT-proBNP or IL-6 levels, the mortality was not reduced. Only elevated cTnT was independently associated with future MI and a reduction of MI by means of an invasive strategy. CONCLUSIONS N-terminal proBNP is independently associated with mortality. The combination of NT-proBNP and IL-6 seems to be a usefull tool in the identification of patients with a definite survival benefit from an early invasive strategy. Only cTnT is independently associated with future MI and a reduction of MI by an invasive strategy. (C) 2003 by the American College of Cardiology Foundation.
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页码:1909 / 1916
页数:8
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