Abstract
Background: Acute Coronary Syndrome is one of the commonly diagnosed life threatening condition as of now. Hence it is necessary to diagnose early and assess the severity of disease as soon as possible. This study is done to prove the correlation of cardiac marker NT-pro BNP in Acute Coronary Syndrome.
Aim: To estimate the serum level of N-terminal pro-Brain natriuretic peptide levels in Acute coronary syndrome and its relationship between STEMI, NSTEMI and Unstable angina patients. Also to find the association for levels of NT-pro-BNP in patients with acute coronary syndrome and ejection fraction.
Materials and Methods: 40 patients of age group between 30 to 60 of both sexes who got admitted within 12 hours after onset of symptoms and diagnosed as Acute Coronary Syndrome (STEMI, NSTEMI & Unstable Angina) in Rajah Muthiah Medical College & Hospital at Chidambaram, Tamilnadu during the period of November 2016 to August 2018) without heart failure (≥ Killip class II were excluded) and chronic kidney disease were taken for the present study. The levels of NT-Pro BNP were measure in blood with Rapid NT-Pro BNP Assay kit.
Results: The mean age of the patient was 49-10+7.45 years & majority were males (around 60%). Among ACS NT-pro BNP was higher (>100) in most of the patients (85 %) patients in the study .Here in this study majority patients was STEMI (57.5%) followed by NSTEMI (25%) & Unstable Angina (7%). The majority of patients with low Ejection Fraction had greater NT pro BNP (N=4, 66.7%) and majority of normal Ejection Fraction (N=5, 62.5%) had lower NT pro BNP (<100) which was statistically significant.
Conclusion: NT-pro BNP is reliable biomarker in diagnosing not only STEMI & NSTEMI but also in unstable angina. NT-pro BNP is high in STEMI compared to NSTEMI & UA. Levels of NT-pro BNP is significantly had inverse proportion to Ejection Fraction. Low NT-proBNP levels at the time of admission rule out high-risk patients and patients with heart failure.
Keywords: Acute Coronary Syndromes, STEMI, NSTEMI, Unstable Angina, NT-pro BNP, cardiac markers.
References
- World Health Organisation, Cardio-vascular diseases (CVDs), Published on 17 May 2017 http://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)
- Harrison Principles of internal medicine 19th edition, chapter 294
- Braunwald E, et al. Unstable angina : diagnosing and management . Rockwille, Md: U.S. Dept.of Health and Human Services, Public Health Agency for Health Care Policy and Research, National Heart, Lung, and Blood Institute, 1994; Clinical practice guideline no.; AHCPR publication no.94-0602
- Wagner GS, Marriott HJ. Marriott’s Practical electrocardiography. 10th ed. Philadelphia: Lippincott Williams & Wilkins, 2001:165.
- Goldberger AL. Clinical electro - cardiography: a simplified approach. 6th ed. St. Louis: Mosby, 1999: 81–100.
- Karras DJ, Kane DL. Serum markers in the emergency department diagnosis of acute myocardial infarction. Emerg Med Clin North Am. 2001;19:321–37.
- Hamm CW, Goldmann BU, Heeschen C, Kreymann G, Berger J, Meinertz T. Emergency room triage of patients with acute chest pain by means of rapid testing for cardiac troponin T or troponin I. N Engl J Med. 1997;337:1648–53
- Pope JH, Selker HP. Diagnosis of acute cardiac ischemia. Emerg Med Clin North Am. 2003;21:27–59.
- Balk EM, Ioannidis JP, Salem D, Chew PW, Lau J. Accuracy of biomarkers to diagnose acute cardiac ischemia in the emergency department: a meta-analysis. Ann Emerg Med. 2001;37:478–94
- Mantymaa P, Vuolteenaho O, Marttila M et al. Atrial stretch in-duces rapid increase in brain natriuretic peptide but not in atrial natriuretic peptide gene expression in vitro. Endocrinology, 1993;133:1470-1473.
- Levin ER, Gardner DG, Samson WK.Natriuretic peptides.N Engl J Med, 1998;339:321-328.
- Bettencourt P, Ferreira A, Pardal- Oliveira Ne al. Clinical Significance of brain natriuretic peptide in patients with postmyocardial infarction. Clin Cardiol,2000 ;23:921-927.
- Jernberg T, Stridsberg M, Venge P et al. N-terminal pro brain natriuretic peptide on admission for early risk stratification of patients with chest pain and no ST – segment elevation. J Am Coll Cardiol, 2002;40:437-445.
- Heeschen C, Hamm CW, Mitrovic V.Prognostic value of B type natriuretic peptide in patients with acute coronary syndromes, Eur heart J,2002;23:383.
- Galvani M,Ottani F, Oltrona L et al.; Italian Working group on Ath reosclerosis, Thrombosis, and Vasucular Biology and the Associazione Nazionale Medici Cardiologi n Ospedalieri (ANMCO). N- terminal pro-brain natriuretic peptide on admission has prognostic value across the whole spectrum of acute coronary syndromes. Circulation ,2004;110:128-134.
- Weber M, Kleine C, Keil E et al.Release pattern of N- terminal pro B- type natriuretic peptide (NT-proBNP) in acute coronary syndromes. Clin Res Cardiol,2006;95:270-280.
- Ogawa A , Seino Y, Yamashita T et al. 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,2006; 70:1372-1378.
- Januzzi J,Camargo C, anwaruddin S.The N-terminal pro-BNP investigation of Dyspnea emergency Department (PRIDE) Study. Am J Cardiol.2005;95:948-954.
- Mueller C, Scholer A, Laule-Kilian K.Use of B-type natriuetic pepetide in the evaluation and management of acute dyspnea. N Engl J Med .2004;350:647-654.
- Vladimir Zdravkovic et al. NT-proBNP for prognostic and diagnostic evaluation in patients with acute coronary syndromes, Kardiologia Polska 2013; 71, 5: 472–479; DOI: 10.5603/KP.2013.0093
- Amulya C. Belagavi et al. Indian Heart J. 2012 May; 64(3): 302–304.
Corresponding Author
Prof Dr M. Senthilvelan
Professor & HOD, Department of General Medicine, Rajah Muthiah Medical College, Annamalai University, Chidambaram, Tamilnadu, India
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.