N-terminal pro-brain natriuretic peptide for additional risk stratification in patients with non-ST-elevation acute coronary syndrome and an elevated troponin T: An Invasive versus Conservative Treatment in Unstable coronary Syndromes (ICTUS) substudy

Fons Windhausen; Alexander Hirsch; Gerard T. Sanders; Jan P.Hein Cornel; Johan Fischer; Jan van Straalen; Jan G.P. Tijssen; Freek W.A. Verheugt; Robbert J. de Winter

doi:10.1016/j.ahj.2006.12.012

N-terminal pro-brain natriuretic peptide for additional risk stratification in patients with non-ST-elevation acute coronary syndrome and an elevated troponin T: An Invasive versus Conservative Treatment in Unstable coronary Syndromes (ICTUS) substudy

Fons Windhausen, Alexander Hirsch, Gerard T. Sanders, Jan P.Hein Cornel, Johan Fischer, Jan van Straalen, Jan G.P. Tijssen, Freek W.A. Verheugt, Robbert J. de Winter^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

42 Citations (Scopus)

Abstract

Background: New evidence has emerged that the assessment of multiple biomarkers such as cardiac troponin T (cTnT) and N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with non-ST-elevation acute coronary syndrome (nSTE-ACS) provides unique prognostic information. The purpose of this study was to assess the association between baseline NT-proBNP levels and outcome in patients who have nSTE-ACS with an elevated cTnT and to determine whether patients with elevated NT-proBNP levels benefit from an early invasive treatment strategy. Methods: Baseline samples for NT-proBNP measurements were available in 1141 patients who have nSTE-ACS with an elevated cTnT randomized to an early or a selective invasive strategy. Patients were followed-up for the occurrence of death, myocardial infarction (MI), and rehospitalization for angina. Results: We showed that increased levels of NT-proBNP were associated with several indicators of risk and severe coronary artery disease. Mortality by 1 year was 7.3% in the highest quartile (≥1170 ng/L for men, ≥2150 ng/L for women) compared with 1.1% of patients in the lower 3 quartiles (P < .0001). N-terminal pro-brain natriuretic peptide (highest quartile vs lower 3 quartiles) was a strong independent predictor of mortality (hazard ratio 5.0, 95% CI 2.1-11.6, P = .0002). However, NT-proBNP levels were not associated with the incidence of recurrent MI by 1 year. Furthermore, we could not demonstrate a benefit of an early invasive strategy compared with a selective invasive strategy in patients with an elevated NT-proBNP level. Conclusions: We confirmed that NT-proBNP is a strong independent predictor of mortality by 1 year but not of recurrent MI in patients who have nSTE-ACS with an elevated cTnT. We could not demonstrate a benefit of an early invasive strategy compared with a selective invasive strategy.

Original language	English
Pages (from-to)	485-492
Number of pages	8
Journal	American Heart Journal
Volume	153
Issue number	4
DOIs	https://doi.org/10.1016/j.ahj.2006.12.012
Publication status	Published - Apr 2007
Externally published	Yes

Bibliographical note

Funding Information:
The ICTUS study was supported by the Interuniversitary Cardiology Institute of the Netherlands; the Working Group on Cardiovascular Research of the Netherlands; and educational grants from Eli Lilly (Houten, The Netherlands), Sanofi/Synthelabo (Gouda, The Netherlands), Aventis (Gouda, The Netherlands), Pfizer (Capelle a/d IJsel, The Netherlands), and Medtronic (Heerlan, The Netherlands), Roche Diagnostics (Almere, The Netherlands) kindly provided the reagents for measurements of cardiac troponin T and N-terminal pro–brain natriuretic peptide in the core laboratory.

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Windhausen, F., Hirsch, A., Sanders, G. T., Cornel, J. P. H., Fischer, J., van Straalen, J., Tijssen, J. G. P., Verheugt, F. W. A., & de Winter, R. J. (2007). N-terminal pro-brain natriuretic peptide for additional risk stratification in patients with non-ST-elevation acute coronary syndrome and an elevated troponin T: An Invasive versus Conservative Treatment in Unstable coronary Syndromes (ICTUS) substudy. American Heart Journal, 153(4), 485-492. https://doi.org/10.1016/j.ahj.2006.12.012

Windhausen, Fons ; Hirsch, Alexander ; Sanders, Gerard T. et al. / N-terminal pro-brain natriuretic peptide for additional risk stratification in patients with non-ST-elevation acute coronary syndrome and an elevated troponin T : An Invasive versus Conservative Treatment in Unstable coronary Syndromes (ICTUS) substudy. In: American Heart Journal. 2007 ; Vol. 153, No. 4. pp. 485-492.

@article{2a6b86ea55b041fd866b6db47e808b5e,

title = "N-terminal pro-brain natriuretic peptide for additional risk stratification in patients with non-ST-elevation acute coronary syndrome and an elevated troponin T: An Invasive versus Conservative Treatment in Unstable coronary Syndromes (ICTUS) substudy",

abstract = "Background: New evidence has emerged that the assessment of multiple biomarkers such as cardiac troponin T (cTnT) and N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with non-ST-elevation acute coronary syndrome (nSTE-ACS) provides unique prognostic information. The purpose of this study was to assess the association between baseline NT-proBNP levels and outcome in patients who have nSTE-ACS with an elevated cTnT and to determine whether patients with elevated NT-proBNP levels benefit from an early invasive treatment strategy. Methods: Baseline samples for NT-proBNP measurements were available in 1141 patients who have nSTE-ACS with an elevated cTnT randomized to an early or a selective invasive strategy. Patients were followed-up for the occurrence of death, myocardial infarction (MI), and rehospitalization for angina. Results: We showed that increased levels of NT-proBNP were associated with several indicators of risk and severe coronary artery disease. Mortality by 1 year was 7.3\% in the highest quartile (≥1170 ng/L for men, ≥2150 ng/L for women) compared with 1.1\% of patients in the lower 3 quartiles (P < .0001). N-terminal pro-brain natriuretic peptide (highest quartile vs lower 3 quartiles) was a strong independent predictor of mortality (hazard ratio 5.0, 95\% CI 2.1-11.6, P = .0002). However, NT-proBNP levels were not associated with the incidence of recurrent MI by 1 year. Furthermore, we could not demonstrate a benefit of an early invasive strategy compared with a selective invasive strategy in patients with an elevated NT-proBNP level. Conclusions: We confirmed that NT-proBNP is a strong independent predictor of mortality by 1 year but not of recurrent MI in patients who have nSTE-ACS with an elevated cTnT. We could not demonstrate a benefit of an early invasive strategy compared with a selective invasive strategy.",

author = "Fons Windhausen and Alexander Hirsch and Sanders, \{Gerard T.\} and Cornel, \{Jan P.Hein\} and Johan Fischer and \{van Straalen\}, Jan and Tijssen, \{Jan G.P.\} and Verheugt, \{Freek W.A.\} and \{de Winter\}, \{Robbert J.\}",

note = "Funding Information: The ICTUS study was supported by the Interuniversitary Cardiology Institute of the Netherlands; the Working Group on Cardiovascular Research of the Netherlands; and educational grants from Eli Lilly (Houten, The Netherlands), Sanofi/Synthelabo (Gouda, The Netherlands), Aventis (Gouda, The Netherlands), Pfizer (Capelle a/d IJsel, The Netherlands), and Medtronic (Heerlan, The Netherlands), Roche Diagnostics (Almere, The Netherlands) kindly provided the reagents for measurements of cardiac troponin T and N-terminal pro–brain natriuretic peptide in the core laboratory. ",

year = "2007",

month = apr,

doi = "10.1016/j.ahj.2006.12.012",

language = "English",

volume = "153",

pages = "485--492",

journal = "American Heart Journal",

issn = "0002-8703",

publisher = "Elsevier Inc.",

number = "4",

}

Windhausen, F, Hirsch, A, Sanders, GT, Cornel, JPH, Fischer, J, van Straalen, J, Tijssen, JGP, Verheugt, FWA & de Winter, RJ 2007, 'N-terminal pro-brain natriuretic peptide for additional risk stratification in patients with non-ST-elevation acute coronary syndrome and an elevated troponin T: An Invasive versus Conservative Treatment in Unstable coronary Syndromes (ICTUS) substudy', American Heart Journal, vol. 153, no. 4, pp. 485-492. https://doi.org/10.1016/j.ahj.2006.12.012

N-terminal pro-brain natriuretic peptide for additional risk stratification in patients with non-ST-elevation acute coronary syndrome and an elevated troponin T: An Invasive versus Conservative Treatment in Unstable coronary Syndromes (ICTUS) substudy. / Windhausen, Fons; Hirsch, Alexander; Sanders, Gerard T. et al.
In: American Heart Journal, Vol. 153, No. 4, 04.2007, p. 485-492.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - N-terminal pro-brain natriuretic peptide for additional risk stratification in patients with non-ST-elevation acute coronary syndrome and an elevated troponin T

T2 - An Invasive versus Conservative Treatment in Unstable coronary Syndromes (ICTUS) substudy

AU - Windhausen, Fons

AU - Hirsch, Alexander

AU - Sanders, Gerard T.

AU - Cornel, Jan P.Hein

AU - Fischer, Johan

AU - van Straalen, Jan

AU - Tijssen, Jan G.P.

AU - Verheugt, Freek W.A.

AU - de Winter, Robbert J.

N1 - Funding Information: The ICTUS study was supported by the Interuniversitary Cardiology Institute of the Netherlands; the Working Group on Cardiovascular Research of the Netherlands; and educational grants from Eli Lilly (Houten, The Netherlands), Sanofi/Synthelabo (Gouda, The Netherlands), Aventis (Gouda, The Netherlands), Pfizer (Capelle a/d IJsel, The Netherlands), and Medtronic (Heerlan, The Netherlands), Roche Diagnostics (Almere, The Netherlands) kindly provided the reagents for measurements of cardiac troponin T and N-terminal pro–brain natriuretic peptide in the core laboratory.

PY - 2007/4

Y1 - 2007/4

N2 - Background: New evidence has emerged that the assessment of multiple biomarkers such as cardiac troponin T (cTnT) and N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with non-ST-elevation acute coronary syndrome (nSTE-ACS) provides unique prognostic information. The purpose of this study was to assess the association between baseline NT-proBNP levels and outcome in patients who have nSTE-ACS with an elevated cTnT and to determine whether patients with elevated NT-proBNP levels benefit from an early invasive treatment strategy. Methods: Baseline samples for NT-proBNP measurements were available in 1141 patients who have nSTE-ACS with an elevated cTnT randomized to an early or a selective invasive strategy. Patients were followed-up for the occurrence of death, myocardial infarction (MI), and rehospitalization for angina. Results: We showed that increased levels of NT-proBNP were associated with several indicators of risk and severe coronary artery disease. Mortality by 1 year was 7.3% in the highest quartile (≥1170 ng/L for men, ≥2150 ng/L for women) compared with 1.1% of patients in the lower 3 quartiles (P < .0001). N-terminal pro-brain natriuretic peptide (highest quartile vs lower 3 quartiles) was a strong independent predictor of mortality (hazard ratio 5.0, 95% CI 2.1-11.6, P = .0002). However, NT-proBNP levels were not associated with the incidence of recurrent MI by 1 year. Furthermore, we could not demonstrate a benefit of an early invasive strategy compared with a selective invasive strategy in patients with an elevated NT-proBNP level. Conclusions: We confirmed that NT-proBNP is a strong independent predictor of mortality by 1 year but not of recurrent MI in patients who have nSTE-ACS with an elevated cTnT. We could not demonstrate a benefit of an early invasive strategy compared with a selective invasive strategy.

AB - Background: New evidence has emerged that the assessment of multiple biomarkers such as cardiac troponin T (cTnT) and N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with non-ST-elevation acute coronary syndrome (nSTE-ACS) provides unique prognostic information. The purpose of this study was to assess the association between baseline NT-proBNP levels and outcome in patients who have nSTE-ACS with an elevated cTnT and to determine whether patients with elevated NT-proBNP levels benefit from an early invasive treatment strategy. Methods: Baseline samples for NT-proBNP measurements were available in 1141 patients who have nSTE-ACS with an elevated cTnT randomized to an early or a selective invasive strategy. Patients were followed-up for the occurrence of death, myocardial infarction (MI), and rehospitalization for angina. Results: We showed that increased levels of NT-proBNP were associated with several indicators of risk and severe coronary artery disease. Mortality by 1 year was 7.3% in the highest quartile (≥1170 ng/L for men, ≥2150 ng/L for women) compared with 1.1% of patients in the lower 3 quartiles (P < .0001). N-terminal pro-brain natriuretic peptide (highest quartile vs lower 3 quartiles) was a strong independent predictor of mortality (hazard ratio 5.0, 95% CI 2.1-11.6, P = .0002). However, NT-proBNP levels were not associated with the incidence of recurrent MI by 1 year. Furthermore, we could not demonstrate a benefit of an early invasive strategy compared with a selective invasive strategy in patients with an elevated NT-proBNP level. Conclusions: We confirmed that NT-proBNP is a strong independent predictor of mortality by 1 year but not of recurrent MI in patients who have nSTE-ACS with an elevated cTnT. We could not demonstrate a benefit of an early invasive strategy compared with a selective invasive strategy.

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DO - 10.1016/j.ahj.2006.12.012

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SN - 0002-8703

VL - 153

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JO - American Heart Journal

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Windhausen F, Hirsch A, Sanders GT, Cornel JPH, Fischer J, van Straalen J et al. N-terminal pro-brain natriuretic peptide for additional risk stratification in patients with non-ST-elevation acute coronary syndrome and an elevated troponin T: An Invasive versus Conservative Treatment in Unstable coronary Syndromes (ICTUS) substudy. American Heart Journal. 2007 Apr;153(4):485-492. doi: 10.1016/j.ahj.2006.12.012

N-terminal pro-brain natriuretic peptide for additional risk stratification in patients with non-ST-elevation acute coronary syndrome and an elevated troponin T: An Invasive versus Conservative Treatment in Unstable coronary Syndromes (ICTUS) substudy

Abstract

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