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N-terminal pro B type natriuretic peptide is better than TIMI risk score at predicting death following acute myocardial infarction
  1. Sohail Q Khan (sqk1{at}
  1. University of Leicester, United Kingdom
    1. Paulene Quinn (pq1{at}
    1. University of Leicester, United Kingdom
      1. Joan E Davies (jed13{at}
      1. University of Leicester, United Kingdom
        1. Leong L Ng (lln1{at}
        1. University of Leicester, United Kingdom


          Background: The TIMI risk score is a well validated scoring system to predict mortality in patients following an ST-segment elevation myocardial infarction (STEMI). N-terminal pro B type natriuretic peptide (NTproBNP) has also been found to be useful in predicting mortality following STEMI. We sought to investigate the utility of TIMI score and NTproBNP levels at predicting risk of death in acute myocardial infarction (AMI) patients.

          Methods: We studied 473 patients (352 men, mean age 63.7 ± 12.3 years) with AMI. Blood was drawn within 24 hours following the onset of chest pain and the plasma concentration of NTproBNP was determined using an in-house non-competitive immunoassay. Patients were TIMI risk scored and stratified into low (0 to 2), intermediate (3 to 7) and high risk (>8) groups.

          Results: Mortality was 8.9% and was related to higher TIMI risk scores (p=0.029 for trend). Higher NTproBNP levels were also related to increased mortality (median [range] fmol/ml, survivors 700.2[0.3-11485.3] vs. dead 5781.3[1.4-10835.9], p<0.0001). In a multivariate binary logistic regression model, independent predictors of mortality were NTproBNP levels in the first 24 hours (OR 4.21, 95% CI: 1.96-9.07, p<0.001) along with drug therapies. The receiver-operating curve for NTproBNP in the first 24 hours yielded an area under the curve (AUC) of 0.79 (95% CI: 0.70-0.88, p<0.001), for TIMI risk score the AUC was 0.67 (95% CI: 0.58-0.76, p=0.001).

          Conclusion: In the first 24 hours following an AMI, NTproBNP is superior to TIMI risk scoring at predicting mortality. A simple NTproBNP blood test is more easily applicable and is more accurate than a clinical risk score.

          • Acute Myocardial Infarction
          • NTproBNP
          • Prognosis
          • TIMI risk score

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