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

Amsterdam UMC
North West Hospital Group
Radboud University Medical Center

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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U2 - 10.1016/j.ahj.2006.12.012

DO - 10.1016/j.ahj.2006.12.012

M3 - Article

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AN - SCOPUS:33947314845

SN - 0002-8703

VL - 153

SP - 485

EP - 492

JO - American Heart Journal

JF - American Heart Journal

IS - 4

ER -

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

Bibliographical note

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