Relative value of N-terminal probrain natriuretic peptide, TIMI risk score, ACC/AHA prognostic classification and other risk markers in patients with non-ST-elevation acute coronary syndromes

Aims We prospectively studied the additive value of N-terminal probrain natriuretic peptide (NT-proBNP) in relation to the Thrombolysis in Myocardial Infarction (TIMI) risk score and the American College of Cardiology/American Heart Association (ACC/AHA) joint prognostic classification, and compared the predictive capacity of NT-proBNP, troponin T (TnT), C-reactive protein (hsCRP), myoglobin, and creatine kinase-MB (CK-MB) concentrations in a cohort of 1483 consecutive patients with non-ST-segment-elevation acute coronary syndromes (NSTE-ACS). Methods and results Centralised measurements of NT-proBNP, TnT, myoglobin, and hsCRP were performed 3 h (median) after admission. Adjusting by clinical, ECG variables, and biomarkers, NT-proBNP concentration was the strongest independent predictor of in-hospital (OR 1.7, 95% CI: 1.31–2.20, \(p{<}.001\) ⁠) and 180-day mortality (OR 1.67, 95% CI: 1.41–1.99, \(p{<}.001\) ⁠), and added significant prognostic information to the TIMI and ACC/AHA prognostic categories. NT-proBNP was not an independent predictor of risk of new myocardial infarction, even in the acute or long term. Conclusions In NSTE-ACS, NT-proBNP adds substantial information to the TIMI risk score and the ACC/AHA classification. Compared to other biomarkers, NT-proBNP is the strongest independent predictor of in-hospital and 180-day mortality.