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Clinical Chemistry and Laboratory Medicine (CCLM)

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The value of N-terminal proB-type natriuretic peptide for early identification of myocardial infarction in patients with high-risk non-ST-elevation acute coronary syndromes

Robert K. Riezebos
  • Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
  • :
/ Gerrit J. Laarman
  • TweeSteden Ziekenhuis, Tilburg, The Netherlands
/ Jan G.P. Tijssen
  • Academic Medical Center – University of Amsterdam, Amsterdam, The Netherlands
/ Freek W.A. Verheugt
  • Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
Published Online: 2011-06-22 | DOI: https://doi.org/10.1515/CCLM.2011.213


Background: N-terminal proB-type natriuretic peptide (NT-proBNP) is a marker of biomechanical strain, secreted by cardiomyocytes in response to ischemia. As necrosis occurs after prolonged ischemia, a rise in NT-proBNP concentration could precede a rise in markers of necrosis.

Methods: The aim of the study was to evaluate whether NT-proBNP is able to identify those patients with an evolving myocardial infarction (MI) with high-risk non-ST-elevation acute coronary syndromes (NSTE-ACS). Data were analyzed from a prospective cohort of 103 high-risk NSTE-ACS patients admitted within 6 h after onset of pain and treated with an early invasive strategy. NT-proBNP samples, obtained immediately upon admission, were related to the presence of an in hospital MI. The optimal cut-off value for NT-proBNP was determined using receiver-operating characteristics (ROC) curve analysis.

Results: Analyses was performed separately for creatinine kinase MB-mass (CKMB) and troponin T (TnT) based MI definitions. In both cases, a NT-proBNP concentration above 40 pmol/L (339 ng/L) at admission proved to be independently associated with the presence of MI. The diagnostic odds ratio (OR) for CKMB-MI was 4.9 (confidence interval 2.0–11.9, p<0.001). The diagnostic OR for TnT-MI was 4.9 (1.8–14.4, p=0.003). Adjusting for differences in baseline variables did not weaken the diagnostic OR. In addition, elevated NT-proBNP concentrations were related to unfavour-able demographic, physical and biochemical parameters.

Conclusions: With a dichotomous cut-off value, a single elevated NT-proBNP (>40 pmol/L) at admission provides independent information about the presence of MI in high-risk NSTE-ACS patients.

This article offers supplementary material which is provided at the end of the article.

Keywords: acute coronary syndrome; myocardial infarction; N-terminal proB-type natriuretic peptide (NT-proBNP); troponin

Corresponding author: Robert K. Riezebos, Department of Cardiology, Onze Lieve Vrouwe Gasthuis, PO Box 95500, 1090 HM Amsterdam, The Netherlands

Received: 2010-11-08

Accepted: 2011-03-21

Published Online: 2011-06-22

Published in Print: 2011-08-01

Citation Information: Clinical Chemistry and Laboratory Medicine. Volume 49, Issue 8, Pages 1359–1365, ISSN (Online) 1437-4331, ISSN (Print) 1434-6621, DOI: https://doi.org/10.1515/CCLM.2011.213, June 2011

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