Prognostic value of point of care B-type natriuretic peptide testing and GRACE score in patients with acute coronary syndrome
10.3760/cma.j.issn.0253-3758.2009.08.010
- VernacularTitle:床旁B型利钠肽检测与全球急性冠状动脉事件注册评分对急性冠状动脉综合征患者的预后价值
- Author:
Yi-Hong SUN
1
;
Gui-Lian WANG
;
Yuan-Yuan FU
;
Chao XUE
;
Da-Yi HU
Author Information
1. 北京大学人民医院
- Keywords:
Coronary disease;
Natriuretic peptide,brain;
Prognosis;
Risk assessment
- From:
Chinese Journal of Cardiology
2009;37(8):716-720
- CountryChina
- Language:Chinese
-
Abstract:
Objective To compare the prognostic value of B-type natriuretic peptide (BNP) and GRACE score in patients with acute coronary syndrome. Methods A total of 246 patients with chest pain to hospital time < 24 hours were followed up to 30 days. Admission plasma B-type natriuretic peptide was measured by point-of-care. Endpoints included death, reinfarction, recurrent ischemia and new onset of congestive heart failure. The receiver operating characteristic (ROC) curve was used to evaluate prognostic value of BNP and GRACE score. The logistic regression models were used to assess the prognostic contribution of BNP level and GRACE score. Results The mean age was (67. 6 ± 12. 0) years (61. 8% males) and ST elevation myocardial infarction (STEMI) was diagnosed in 135 patients (54.9% ). During the follow up, 34 endpoints ( 13. 8% ) were recorded including 9 deaths (3.7%). The systolic blood pressure [(121 ±29)mm Hg vs. (130±23)mm Hg, P=0.034; 1 mm Hg=0. 133 kPa] was significantly lower while the heart rate and plasma creatinin were significantly higher in the endpoints group than in non-endpoints group. TNI and CRP levels were similar between the two groups. The BNP level at admission (median 883.5 ng/L vs. 216.5 ng/L) and GRACE score (median 164.5 vs. 142.0) were significantly higher in the endpoints group than in non-endpoints group (all P <0. 05). The prognostic criteria for BNP level (area under cure, 0.704) was 194.5 ng/L determined by ROC(P=0. 043). For GRACE score, the predictive value for endpoints was 0. 742 ( P = 0. 003 ) and the cut-off point was 158. In the logistic regression model, BNP concentration ( > 194.5 ng/L, OR =3. 174) and GRACE score ( > 158, OR = 4. 031) were independent predictors of endpoints in patients with ACS. Conclusion Both BNP level at admission and GRACE score were independent predictors for endpoints at 30 days in patients with ACS.
