N-Terminal Pro-BNP in Acute Coronary Syndrome Patients with ST Elevation versus Non ST Elevation Myocardial Infarction


The study aimed to evaluate the differences in secretion of NT-proBNP and conventional cardiac markers in patients with STE-ACS vs NSTE-ACS as a trial to solve the dilemma of the early detection of myocardial ischemia in NSTE-ACS. Sixty two patients with acute coronary syndrome (ACS) divided into 2 groups according to ECG: group1 with elevated ST segment in ECG (STE-ACS) and group 2 with non elevated ST segment (NSTE-ACS).Twenty healthy subjects with matched age and sex were enrolled as control group in this study. In the sera of all subjects, levels of NT –proBNP, CK-MB and troponin-T were measured by different kits. CK-MB and TnT were both significantly higher in STE-ACS patients compared to NSTE-ACS patients. Conversely, NT-proBNP was significantly higher in NSTE-ACS patients than STE-ACS especially within 4 hours from onset of chest pain. Comparison between NT-proBNP, TnT and CK-MB levels by ROC curves revealed area under the curves = 0.68, 0.31, 0.17 respectively. NT-proBNP at cutoff 415 pg/mL in NSTE-ACS patients had higher sensitivity and specificity (92%, 39%; respectively) than other markers that will help in earl diagnosis of NSTE-ACS.

Share and Cite:

R. Salama, A. El- Moniem, N. El-Hefney and T. Samor, "N-Terminal Pro-BNP in Acute Coronary Syndrome Patients with ST Elevation versus Non ST Elevation Myocardial Infarction," International Journal of Clinical Medicine, Vol. 2 No. 3, 2011, pp. 218-223. doi: 10.4236/ijcm.2011.23036.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Y. Seino, A. Ogawa, T .Yamashita, M. Fukushima, K. Ogata, H. Fukumoto, T. Takano, “Application of NT- proBNP and BNP measurements in cardiac care: A more discerning marker for the detection and evaluation of heart failure”, Eur. J. Heart Fail., Vol. 6, No. 3, 2004, pp 295-300.
[2] N. van der Burg-de Graauw, C.M Cobbaert , C .J Middelhoff , T.A Bantje, .van Guldener, “The additive value of N-terminal pro-B-type natriuretic peptide testing at the emergency department in patients with acute dyspnea”, Eur. J. Intern. Med., Vol. 20, No. 3, 2009, pp 301-6.
[3] P.R Fox, M.A Oyama, C. Reynolds, J.E Rush, T.C Defrancesco, B.W Keene, C.E Atkins, K.A Macdonald , K. ESchober , J.D Bonagura , R.L Stepien , H.B Kellihan, T.P Nguyenba, L.B Lehmkuhl, B.K Lefbom, N.S Moise , D.F Hogan, “Utility of plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) to distinguish between congestive heart failure and non-cardiac causes of acute dyspnea in cats”, J Vet Cardiol., Vol. 11, Suppl 1, 2009, pp S51-61
[4] L. Lorgis, M. Zeller, G. Dentan, P. Sicard, P. Buffet , I. L’Huillier, J. C. Beer, M. Vincent-Martin, H. Makki, P .Gambert, Y. Cottin, “RICO Survey Working Group: Prognostic value of N-terminal pro-brain natriuretic peptide in elderly people with acute myocardial infarction: prospective observational study”, BMJ, Vol. 6, No.338, 2009, pp b1605.
[5] M. Heringlake, T. Kox, J. Poeling, S. Klaus, T. Hanke, N. Franz, F. Eberhardt, H. Heinze, F. P. Armbruster, L. Bahlmann, “The effects of physical exercise on plasma levels of relaxin, NTproANP, and NTproBNP in patients with ischemic heart disease”, Eur. J. Med. Res., Vol. 14, No. 3, 2009, pp 106-12.
[6] O. Bruder, C. Jensen, M. Jochims, M. Farazandeh, J. Barkhausen, T. Schlosser, G.V Sabin, P. Hunold, “Relation of B-type natriuretic peptide (BNP) and infarct size as assessed by contrast-enhanced MRI”, Int. J. Cardiol., Vol. 24,No. 144;1 ,2009, pp 53-8.
[7] S. Garcia, M. S Akbar, S.SAli , F. Kamdar, M.Y Tsai, D.A Duprez, “N-terminal pro B-type natriuretic peptide predicts mortality in patients with left ventricular hypertrophy”, Int J Cardiol., Vol.143, No. 3, 2009, pp 349-52.
[8] J. Alpert, K. Thygesen, E. Antman, J.P Bassand, “Myocardial infarction redefined: A consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction”, J Am Coll Cardiol., Vol.36, 2000, pp 959-969.
[9] E. Braunwald, E .Antman, J. Beasley, R.M Califf, M.D Cheitlin, J.S Hochman, R.H Jones, D .Kereiakes, et al., “ACC/AHA guidelines for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients with Unstable Angina)”, J Am Coll Cardiol., Vol. 36, 2000, pp 970-1062
[10] D .Sahn, A. DeMaria, J. Kisslo, et al., “Recommendations regarding quantitation in M-mode echocardiography: Results of a survey of echocardiographic measurements”, Circulation,Vol. 58, 1978, pp 1072-1083.
[11] B. Haastrup, S. Gill, S. Kristensen, et al., “Biochemical markers of ischemia for the early identification of acute myocardial infarction without St segment elevation”, Cardiology, Vol. 94, 2000, pp 254-261.
[12] Y. Seino, K. Ogata, T .Takano, et al., “Use of a whole blood rapid panel test for heart-type fatty acid-binding protein in patients with acute chest pain: Comparison with rapid troponin T and myoglobin tests”, Am. J. Med., Vol. 115, 2003, pp 185-190.
[13] K .Bibbins-Domingo, M .Ansari, N.B. Schiller, B. Massie, M. A Whooley, “B-type natriuretic peptide and ischemia in patients with stable coronary disease: data from the Heart and Soul study”, Circulation, Vol. 108, No. 24, 2003, pp 2987-92.
[14] M. Weber, T. Dill, R. Arnold, M. Rau, O. Ekinci , K.D .Müller, A. Berkovitsch,V. Mitrovic, C. Hamm , “N-terminal B-type natriuretic peptide predicts extent of coronary artery disease and ischemia in patients with stable angina pectoris”, Am. Heart J.,Vol. 148, No. 4, 2004, pp 612-20.
[15] J .Goetze, C. Christoffersen, M .Perko, H. Arendrup, J.F. Rehfeld, J. Kastrup, L. B. Nielsen, “Increased cardiac BNP expression associated with myocardial ischemia”, Faseb J., Vol. 17, No. 9, 2003, pp 1105-7.
[16] G.F Baxter, “Natriuretic peptides and myocardial ischaemia”, Basic Res. Cardiol., Vol. 99, 2004, pp 90-3.
[17] Y. Rautureau and G.F Baxter, “Acute actions of natriuretic peptides in coronary vasculature and ischaemic myocardium”, Curr. Pharm. Des., Vol. 10, No. 20, 2004, pp 2477-82.
[18] J. Januzzi, A. Chen-Tournoux, G. Moe, “Amino-Terminal Pro–B-Type Natriuretic Peptide Testing for the Diagnosis or Exclusion of Heart Failure in Patients with Acute Symptoms” Am. J. Cardiol., Vol. 101, [suppl], 2008, pp 29A–38A.
[19] A. Ogawa, Y. Seino, T. Yamashita , K. Ogata , T. Takano, “Difference in elevation of N-terminal pro-BNP and conventional cardiac markers between patients with ST elevation vs non-ST elevation acute coronary syndrome”, Circ. J., Vol. 70, No. 11, 2006, pp 1372-8.
[20] A. Tu?cu, O. Y?ld?r?mtürk, S. Aytekin. The diagnostic value of N-terminal B-type natriuretic peptide in diastolic heart failure: comparison with echocardio-graphic findings. Turk. Kardiyol. Dern. Ars., Vol. 37, No. 2, 2009, pp 112-121.
[21] T. Omland, J .de Lemos, D .Morrow, et al., “Prognostic value of N-terminal pro-atrial and pro-brain natriuretic peptide in patients with acute coronary syndromes”, Am. J. Cardiol.,Vol. 89, 2002, pp 463-465.
[22] T. Omland, A. Persson, L. Ng, et al., “N-terminal pro-B-type natriuretic peptide and long-term mortality in acute coronary syndromes”, Circulation, Vol. 106, 2002, pp 2913-2918.

Copyright © 2024 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.