|
|
|
|
|
| Predictive value of POCT of NT－ proBNP for in－ hospital major adverse cardiovascular eventsamong emergency department patients with acute coronary syndrome |
| Yan Bo, Qin Jian, Liu Fang－yan, Liang Xiao |
| Department of Emergency, Xuanwu Hospital, Capital Medical University, Beijing 100053,China |
|
|
|
|
Abstract Objective To investigate the predictive value of POCT of NT－proBNP for in－hospital major adverse cardiovascular events（MACE）among ER patients with acute coronary syndrom （ACS）.Methods 164 patients diagnosed as ACS were selected, including 83 cases of non－ST segment elevated ACS（NSTEACS）and 81 cases of ST segment elevated ACS（STEACS）. The levels of NT－proBNP and other bio－markers of all the patients were measured within 10 minutes after ER admitting. The average length of time from acute attack to POCT was（6.73±6.57）hours. The recorded in－hospital MACE beforereperfusion therapy included acute heart failure（AHF）, ventricular arrhythmias with hemodynamic instability（VA）and all－cause death（ACD）. The patients were divided into 2 groups: patients with inhospital MACE（group A）and patients without in－hospital MACE（group B）. The correlation between the inhospital MACE and the clinical index which had significant difference between the two groups was judged by the single factor analysis. The significant correlation index was analyzed by the Logistic regression to screen the independent risk factor. The area under receiver operating characteristic curve（AUROC）was used to evaluate the prediction efficiency of independent risk factor for the in － hospital MACE. Results There were 53 cases of in－hospital MACE（32.32%）, 11 cases of death（6.71%）.The NTproBNP levels of group A and B were（10 533.11±9346.76）pg/mL vs.（457.75±448.77）pg/mL（P＜0.001）. The single factor analysis showed that age, heart rate, cTnI, Myo, NT－proBNP, Fib, D－dimer, WBC, CRE, UA were associated with in－hospital MACE in patients with ACS（P＜0.05）. Logistic regression analysis showed that NT－proBNP（P＜0.001, OR＝1.003, 95%CI: 1.001～1.005）was an independent predictive factor. By using NT－proBNP for predicting in－hospital MACE, the AUROC was 0.973（95% CI: 0.942～1.000）, the cutoff value was 2016 pg/mL（sensitivity: 0.943, specificity:1.000, negative predictive value: 0.974, positive predictive value: 1.000）. For predicting the single end events AHF, VA and ACD, the AUROCs were respectively 0.983（95%CI: 0.960～1.000）, 0.916（95%CI: 0.830～1.000）and 0.961（95%CI: 0.932～0.990）; the cutoff values were respectively 2016 pg/mL,5817 pg/mL and 8072 pg/mL. Conclusion POCT of NT－proBNP is a fast, efficient and accurate way to predict the in－ hospital MACE independently among emergency patients with ACS before reperfusion. When NT－proBNP levels are respectively greater than 2016 pg/mL, 5817 pg/mL and 8072 pg/mL,the in－hospital AHF, VA and ACD should be alerted.
|
|
Received: 13 November 2016
|
|
Corresponding Authors:
Qin Jian, E－mail: jqin6@163.com
|
| About author:: Qin Jian, E－mail: jqin6@163.com |
|
|
|
|
|
|
Address: 1 North 2nd Street,
Zhongguancun, 