Abstract
Objectives:This study was conducted to evaluate the diagnostic and prognostic value of B-type natriuretic peptide (BNP) in different categories of acute coronary syndrome (ACS) patients on arrival.Methods:This cohort study included 197 patients admitted in Coronary Care Unit (CCU) of Rehman Medical Institute (RMI) Peshawar from January 2020 to June 2020. Patients were categorized in two subgroups. Subgroup-I with BNP below 100pg/mL. Subgroup-II having BNP above 100pg/mL. Samples were obtained on admission from these patients for Cardiac Troponin I (Trop-i), BNP and serum creatinine. BNP samples were analyzed on Cobas® using chemiluminescence method. Descriptive statistics were derived for age; gender and cardiac biomarkers. Receiver-operating characteristic curves (ROC) were generated. Diagnostic accuracy parameters were determined for Non ST- segment elevation myocardial infarction (STEMI), ST- segment elevation myocardial infarction (STEMI) and unstable angina (UA).Result:One hundred fourteen patients (58.2%) were males and 82 were females (41.8%).Our of this 89 patients were NSTEMI in group II. Mean BNP was 1438±1463.Age distribution shows 120 individuals were over 55 years (61.2%). Hypertension, diabetes, smoking and previous infarcts were the risk factors for ACS. Sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive value (NPV), likelihood ratios, and overall accuracy of BNP at admission for the entire sub categories in ACS (cut-off value 100 pg/mL) were determined by using Trop-i the gold standard. ROC curve showed AUC = 0.557, (95% confidence interval: 0.476–0.638). When Pearson correlation was applied, BNP was found to be a noteworthy independent predictor.Conclusion:BNP can be a useful Biomarker along with standard cardiac biomarkers in various categories of patients with ACS.
Highlights
Ischemic heart disease (IHD) is regarded as one of the important leading causes of disability and death across the globe.[1]
Despite the fact that much research has been done on the significance of B-type natriuretic peptide (BNP) in Heart Failure (HF), the novelty of the current study was to assess if BNP could predict mortality, heart failure, conservative management and cardiovascular events such as atrial fibrillation in patients diagnosed with Acute coronary syndrome (ACS) at RMI’s Coronary Care Unit (CCU). It was a cohort study conducted on 197 eligible participants aged 18 to 80 years irrespective of the gender admitted to the CCU of Rehman Medical Institute (RMI) Peshawar between January to June 2020
Sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive value (NPV), LR+, LR, overall accuracy for Non ST segment- elevation Myocardial infarction (NSTEMI) were 100%, 98.84%, 90.54%, 87.24%, 1.02, 0.99and 90.8% respectively (Fig.1)
Summary
Ischemic heart disease (IHD) is regarded as one of the important leading causes of disability and death across the globe.[1]. Acute coronary syndrome (ACS) applies to a variety of events reporting ischemia, ranging from stable angina without myocardial necrosis to ST –segment elevation myocardial infarction (STEMI).[2]. Thrombosis and atherosclerotic plaque destruction cause ACS to grow. Aside from these two, vasoconstriction is another significant contributor to ACS.[3]. For risk stratification in patients with ACS, serial ECG monitoring and cardiac biomarker measurements are needed as. Pak J Med Sci March - April 2022 (Part-II) Vol 38 No 4 www.pjms.org.pk 970 part of the diagnostic workup.[4]. BNP has shown to be a good indicator of diastolic dysfunction.[5]. It is claimed to be a strong indicator of diagnosis and prognosis in ACS patients.[6]
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