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B-type natriuretic peptide not TIMI risk score predicts death after acute coronary syndrome
Kanit Reesukumal1, Busadee Pratumvinit
1Department of Clinical Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. sikre@mahidol.ac.th
Insights
B-type natriuretic peptide (BNP) levels measured within 12 hours of acute coronary syndrome (ACS) predict long-term mortality more accurately than the TIMI risk score. Higher BNP levels indicate decreased survival in ACS patients.
Area of Science:
- Cardiology
- Biomarkers
- Clinical Risk Stratification
Background:
- The TIMI risk score is a standard tool for predicting mortality in acute coronary syndrome (ACS) patients.
- B-type natriuretic peptide (BNP) is a potential biomarker for assessing risk in ACS.
Purpose of the Study:
- To compare the accuracy of BNP levels versus the TIMI risk score in predicting long-term mortality after ACS.
- To evaluate the utility of early BNP measurement in ACS patient management.
Main Methods:
- 80 ACS patients (mean age 70.68 years) were studied.
- Blood BNP levels were measured within 12 hours of ACS onset.
- Patients were stratified by TIMI risk score (low, intermediate, high).
Main Results:
- Overall 18-month mortality was 20%.
- Higher BNP levels were significantly associated with decreased survival (p < 0.001).
- An optimal BNP cutoff of 250 ng/mL predicted lower survival.
Conclusions:
- Early BNP measurement (within 12 hours) is a more accurate predictor of long-term mortality in ACS than the TIMI risk score.
- BNP offers a practical and effective tool for risk stratification in ACS.
Background:
The TIMI risk score is a clinical scoring system used to predict mortality in patients following an acute coronary syndrome (ACS). B-type natriuretic peptide (BNP) has also been found to be useful in this setting.
Methods:
80 patients (35 men, 45 women) mean (SD) age 70.68 (9.90) years with ACS were studied. Blood was drawn within 12 hours after the onset of ACS and the blood level of BNP was measured using Biosite Triage Cardioprofiler Panel (Biosite Inc., San Diego, CA, USA). Patient's TIMI risk score was recorded and patients were stratified into low (0 - 2), intermediate (3 - 4), and high-risk (5 - 7) groups.
Results:
Overall mortality at 18 months was 20% and was related to BNP levels but not the higher TIMI risk scores. Higher BNP levels were related to decreased survival (median (range) ng/mL, survivors: 166 (5 - 4,710) vs. deceased: 1,093.5 (71.3 - 4,840), p < 0.001). The optimal cutoff for the prediction of survival was 250 ng/mL. ACS patients with BNP over this cutoff have demonstrated the lower survival (log rank p < 0.001).
Conclusions:
BNP measurement within the first 12 hours following an ACS is more easily performed and is more accurate than a clinical risk score at predicting long term mortality.
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