BNP was Associated with Ischemic Myocardial Scintigraphy and Death in Patients at Chest Pain Unit / Associação de BNP com Isquemia na Cintilografia Miocárdica e Morte em Pacientes da Unidade de Dor Torácica

Background: Recent studies have suggested that B-type Natriuretic Peptide (BNP) is an important predictor of ischemia and death in patients with suspected acute coronary syndrome. Increased levels of BNP are seen after episodes of myocardial ischemia and may be related to future adverse events. Objectives: To determine the prognostic value of BNP for major cardiac events and to evaluate its association with ischemic myocardial perfusion scintigraphy (MPS). Methods: This study included retrospectively 125 patients admitted to the chest pain unit between 2002 and 2006, who had their BNP levels measured on admission and underwent CPM for risk stratification. BNP values were compared with the results of the MPS. The chi-square test was used for qualitative variables and the Student t test, for quantitative variables. Survival curves were adjusted using the Kaplan-Meier method and analyzed by using Cox regression. The significance level was 5%. Results: The mean age was 63.9 ± 13.8 years, and the male sex represented 51.2% of the sample. Ischemia was found in 44% of the MPS. The mean BNP level was higher in patients with ischemia compared to patients with non-ischemic MPS (188.3 ± 208.7 versus 131.8 ± 88.6; p = 0.003). A BNP level greater than 80 pg/mL was the strongest predictor of ischemia on MPS (sensitivity = 60%, specificity = 70%, accuracy = 66%, PPV = 61%, NPV = 70%), and could predict medium-term mortality (RR = 7.29, 95% CI: 0.90-58.6; p = 0.045) independently of the presence of ischemia. Conclusions: BNP levels are associated with ischemic MPS findings and adverse prognosis in patients presenting with acute chest pain to the emergency room, thus, providing important prognostic information for an unfavorable clinical outcome. .

Fundamentos: Recentes estudos sugeriram que o peptídeo natriurético do tipo B (BNP) seja um importante fator preditivo de isquemia e morte em pacientes com suspeita de síndrome coronariana aguda. Níveis elevados de BNP são observados após episódios de isquemia miocárdica e podem estar relacionados a futuros eventos adversos. Objetivos: Determinar o valor prognóstico do BNP para eventos cardíacos maiores e avaliar sua associação com cintilografia de perfusão miocárdica (CPM) isquêmica. Métodos: Este estudo incluiu retrospectivamente 125 pacientes admitidos na unidade de dor torácica entre 2002 e 2006, quando seus níveis de BNP foram medidos, tendo sido submetidos a CPM para estratificação de risco. Os níveis de BNP foram comparados com os resultados da CPM. O teste do qui-quadrado foi usado para avaliar as variáveis qualitativas e o teste t de Student, para as quantitativas. Curvas de sobrevida foram ajustadas usando-se o método de Kaplan-Meier e analisadas com regressão de Cox. Adotou-se o nível de significância de 5%. Resultados: A idade média foi de 63,9 ± 13,8 anos, e o sexo masculino correspondeu a 51,2% da amostra. Isquemia foi identificada em 44% das CPM. O BNP médio foi maior em pacientes com isquemia do que naqueles sem isquemia na CPM (188,3 ± 208,7 versus 131,8 ± 88,6; p = 0,003). Um nível de BNP acima de 80 pg/ml mostrou-se o mais forte fator preditivo de isquemia na CPM (sensibilidade = 60%, especificidade = 70%, acurácia = 66%, VPP = 61%, VPN = 70%), tendo sido capaz de predizer morte em médio prazo (RR = 7,29, IC 95%: 0,90-58,6; p = 0,045) independentemente da presença de isquemia. Conclusões: Os níveis de BNP estão associados com achados isquêmicos na CPM e prognóstico adverso em pacientes que se apresentam no setor de emergência queixando-se de dor torácica aguda, fornecendo, portanto, importante informação prognóstica para um desfecho clínico desfavorável. .

BNP was associated with ischemic myocardial scintigraphy and death in patients at chest pain unit.

BACKGROUND: Recent studies have suggested that B-type Natriuretic Peptide (BNP) is an important predictor of ischemia and death in patients with suspected acute coronary syndrome. Increased levels of BNP are seen after episodes of myocardial ischemia and may be related to future adverse events. OBJECTIVES: To determine the prognostic value of BNP for major cardiac events and to evaluate its association with ischemic myocardial perfusion scintigraphy (MPS). METHODS: This study included retrospectively 125 patients admitted to the chest pain unit between 2002 and 2006, who had their BNP levels measured on admission and underwent CPM for risk stratification. BNP values were compared with the results of the MPS. The chi-square test was used for qualitative variables and the Student t test, for quantitative variables. Survival curves were adjusted using the Kaplan-Meier method and analyzed by using Cox regression. The significance level was 5%. RESULTS: The mean age was 63.9 ± 13.8 years, and the male sex represented 51.2% of the sample. Ischemia was found in 44% of the MPS. The mean BNP level was higher in patients with ischemia compared to patients with non-ischemic MPS (188.3 ± 208.7 versus 131.8 ± 88.6; p = 0.003). A BNP level greater than 80 pg/mL was the strongest predictor of ischemia on MPS (sensitivity = 60%, specificity = 70%, accuracy = 66%, PPV = 61%, NPV = 70%), and could predict medium-term mortality (RR = 7.29, 95% CI: 0.90-58.6; p = 0.045) independently of the presence of ischemia. CONCLUSIONS: BNP levels are associated with ischemic MPS findings and adverse prognosis in patients presenting with acute chest pain to the emergency room, thus, providing important prognostic information for an unfavorable clinical outcome.