B-type Natriuretic Peptide in the Early Diagnosis and Risk Stratification of Acute Chest Pain Philip Haaf, MD, Tobias Reichlin, MD, Nils Corson, MD,

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Presentation transcript:

B-type Natriuretic Peptide in the Early Diagnosis and Risk Stratification of Acute Chest Pain Philip Haaf, MD, Tobias Reichlin, MD, Nils Corson, MD, Raphael Twerenbold, MD, Miriam Reiter, MD, Stephan Steuer, MD, Stefano Bassetti, MD, Katrin Winkler, MD, Claudia Stelzig, MSc, Corinna Heinisch, MD, Beatrice Drexler, MD, Heike Freidank, MD, Christian Mueller, MD, FESC The American Journal of Medicine Volume 124, Issue 5, Pages 444-452 (May 2011) DOI: 10.1016/j.amjmed.2010.11.012 Copyright © 2011 Elsevier Inc. Terms and Conditions

Figure 1 Levels of B-type natriuretic peptide (BNP) at presentation to the Emergency Department in all patients according to the adjudicated final diagnosis. Boxes represent interquartile ranges (IQRs), while whiskers display ranges (without outliers further than 1.5 IQRs from the end of the box). CAD=coronary artery disease. The American Journal of Medicine 2011 124, 444-452DOI: (10.1016/j.amjmed.2010.11.012) Copyright © 2011 Elsevier Inc. Terms and Conditions

Figure 2 Diagnostic and prognostic performance of troponin T and B-type natriuretic peptide (BNP) in receiver operating characteristic (ROC) curve analysis. ROC curves describing (A) the diagnostic performance of troponin T and BNP at presentation in the diagnosis of acute myocardial infarction and (B) the prognostic performance of troponin T and BNP in determining all-cause mortality. The American Journal of Medicine 2011 124, 444-452DOI: (10.1016/j.amjmed.2010.11.012) Copyright © 2011 Elsevier Inc. Terms and Conditions

Figure 3 Kaplan-Meier curves for (A) survival in all chest pain patients and (B) survival free of acute myocardial infarction in nonacute myocardial infarction patients. (A) Kaplan-Meier analysis displaying cumulative survival during follow-up in all chest pain patients (n=1075) subdivided into B-type natriuretic peptide (BNP) quartiles. (B) Kaplan-Meier analysis of patients without acute myocardial infarction at presentation (n=907) displaying the combined endpoint of survival free of acute myocardial infarction during follow-up according to BNP quartiles. The American Journal of Medicine 2011 124, 444-452DOI: (10.1016/j.amjmed.2010.11.012) Copyright © 2011 Elsevier Inc. Terms and Conditions

Figure 4 B-type natriuretic peptide (BNP) levels in patients without myocardial infarction at presentation according to different risk categories. BNP levels in patients without myocardial infarction at presentation according to events (death and nonfatal myocardial infarction) during follow-up and according to different risk categories. Risk categories are based on history, physical examination, initial 12-lead electrocardiogram, and troponin T as proposed in the American College of Cardiology/American Heart Association (ACC/AHA) 2007 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction.25 Event rates in the high- (n=246), intermediate- (n=332), and low-risk categories (n=329) were 10%, 4%, and 2%, respectively. The American Journal of Medicine 2011 124, 444-452DOI: (10.1016/j.amjmed.2010.11.012) Copyright © 2011 Elsevier Inc. Terms and Conditions