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      N-terminal pro-B-type natriuretic peptide and long-term mortality in acute coronary syndromes.

      Circulation
      Acute Disease, Aged, Angina, Unstable, blood, diagnosis, mortality, Biological Markers, Cohort Studies, Comorbidity, Coronary Artery Disease, Female, Humans, Male, Middle Aged, Multivariate Analysis, Myocardial Infarction, Natriuretic Peptide, Brain, Nerve Tissue Proteins, Peptide Fragments, Predictive Value of Tests, Prognosis, Regression Analysis, Risk Assessment, Risk Factors, Survival Rate, Survivors, statistics & numerical data, Sweden, epidemiology, Time

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          Abstract

          B-type natriuretic peptide (BNP) is a predictor of short- and medium-term prognosis across the spectrum of acute coronary syndromes (ACS). The N-terminal fragment of the BNP prohormone, N-BNP, may be an even stronger prognostic marker. We assessed the relation between subacute plasma N-BNP levels and long-term, all-cause mortality in a large, contemporary cohort of patients with ACS. Blood samples for N-BNP determination were obtained in the subacute phase in 204 patients with ST-elevation myocardial infarction (MI): 220 with non-ST segment elevation MI and 185 with unstable angina in the subacute phase. After a median follow-up of 51 months, 86 patients (14%) had died. Median N-BNP levels were significantly lower in long-term survivors than in patients dying (442 versus 1306 pmol/L; P<0.0001). The unadjusted risk ratio of patients with supramedian N-BNP levels was 3.9 (95% confidence interval, 2.4 to 6.5). In a multivariate Cox regression model, N-BNP (risk ratio 2.1 [95% confidence interval, 1.1 to 3.9]) added prognostic information above and beyond Killip class, patient age, and left ventricular ejection fraction. Adjustment for peak troponin T levels did not markedly alter the relation between N-BNP and mortality. In patients with no evidence of clinical heart failure, N-BNP remained a significant predictor of mortality after adjustment for age and ejection fraction (risk ratio, 2.4 [95% confidence interval, 1.1 to 5.4]). N-BNP is a powerful indicator of long-term mortality in patients with ACS and provides prognostic information above and beyond conventional risk markers.

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