PURPOSE: The purpose of this study was to assess the frequency of new heart failure, recurrent myocardial infarction (MI) or ischemia and all cause mortality 1 month following acute coronary syndrome (ACS) in patients with normal and elevated plasma B-type natriuretic peptide levels (pBNP) and to determine the effects of myocardial revascularization in such patients.
METHODS: ACS (unstable angina pectoris, non-ST segment elevation MI or ST segment elevation MI) were defined in accordance with standard guidelines. Normal and elevated pBNP were defined as ≤ 80 pg/ml and > 80 pg/ml respectively.
RESULTS: One hundred and forty six patients qualified for the study; 62 with normal and 84 with elevated pBNP. At 1 month new heart failure had occurred in 1 patient with normal pBNP (2%) and in 26 patients with elevated pBNP (31%, p<0.00001). At 1 month all cause mortality had occurred in no patients with normal pBNP and in 8 with elevated pBNP (10%, p<0.015). In subjects with normal pBNP, myocardial revascularization (percutaneous coronary intervention or coronary artery bypass surgery) did not affect the frequency of new heart failure, recurrent MI or ischemia or all cause mortality in patients with normal pBNP. In those with elevated pBNP, new heart failure occurred 19 of 41 unrevascularized patients and in 7 of 39 revascularized patients (p<0.01). All cause mortality occurred in 7 of 41 unrevascularized patients and in 1 of 39 revascularized patients (p<0.05).
CONCLUSION: The presence of elevated pBNP after admission for ACS was associated with a higher frequency of new heart failure and all cause mortality at 1 month. Myocardial revascularization produced a significant reduction in these endpoints in patients with elevated pBNP, but not in those with normal pBNP.
CLINICAL IMPLICATIONS: Elevated pBNP serves as a marker of increased morbidity and mortality in ACS patients and represents a subgroup with a superior response to myocardial revascularization.
DISCLOSURE: Martin Alpert, None.