Natriuretic peptides and multimarker approach to risk stratification of patients with acute coronary syndromes

Natriuretic peptides in acute coronary syndromes Brain natriuretic peptides (BNP) and N-terminal prohormone brain natriuretic peptides (N-proBNP) have been shown to provide important prognostic information in patients with acute coronary syndrome (ACS). Ischemia may be an important stimulus for BNP release. This does not imply, however, that BNP is useful for diagnosing ischemia, and BNP is unlikely to prove sensitive or specific enough for this purpose. Significance of natriuretic peptides in assessing prognosis in patients with acute coronary syndromes In patients with ST-elevation and non-ST-elevation myocardial infarction, higher BNP and N-proBNP levels have been shown to predict a grater likelihood of death or heart faiulure, independent of other prognostic factors. Therapeutic implications of BNP elevation in acute coronary syndromes Patients with BNP or NT-proBNP elevation following ACS are clearly at high risk for death and for developement of heart failure, but specific therapeutic implications of BNP elevation have not been defined. In particular, it is not known how patients with BNP elevation should be treated considering the fact that they have normal troponin levels and no clinical evidence of heart failure. Multimarker strategies for risk stratification in acute coronary syndromes It has been shown recently that in patients with acute coronary syndromes the risk increased sequentially among those with one, two or three elevated biomarkers. Therapeutic applications of cardiac biomarkers in acute coronary syndromes Multimarker strategies, that incorporate panels of cardiac bio?markers, are likely to be used in the future for risk stratification and for pathophysiologically-guided treatement of patients with ACS.