Robert Rudowski

Prognostic value of B-type natriuretic peptide levels on admission in patients with acute ST elevation myocardial infarction

Objective — To assess the relation between B-type natriuretic peptide (BNP) levels on admission in ST elevation myocardial infarction (STEMI) and short-term, all-cause mortality. Methods and results — Blood samples for BNP determination were obtained on admission in 88 patients (mean age 60.6 ± 10.7 years old) with STEMI. In a 15-minute period, BNP was measured by using simple bedside test for rapid quantification of BNP. Thirty days follow-up was performed. During the period of follow-up 12 (13.6%) patients died. Mean BNP was 228.74 ± 269.98 pg/ml.The lowest value was 5 pg/ml, the highest value 1300 pg/ml due to limitations of the method.The baseline level of BNP was higher among patients who died than among those who were alive at 30 days (mean, 545.6 vs. 178.7 pg/ml; P = 0.001). Mortality increased among patients in increasing quartiles (p = 0.009). The unadjusted odds ratio for 30-day risk of death in the fourth quartile was 5.6 (95 percent confidence interval, 1.6 to 20.5; P < 0.001).When BNP was added to a multivariate Cox regression model including clinical and electrocardiographic variables, BNP levels were independently associated with the prognosis. Conclusions — BNP levels obtained on admission are a powerful, independent indicator of shortterm mortality in patients with STEMI. Rapid tests for BNP assay seem to be a new tool in risk stratification of patients with STEMI.