N-Terminal PRO-BNP in Acute Coronary Syndrome Patients with ST Elevation Versus Non ST Elevation in Qassim Region of Saudi Arabia

Aim: To investigate the differences in the secretion of N-terminal pro B-type natriuretic peptide (NT-pro BNP) and conventional cardiac markers in patients with STE-ACS vs. NSTE-ACS as a trial to solve the dilemma of the early detection of myocardial ischemia in NSTE-ACS. Design: Case control hospital based study. Setting: King Fahad Specialist Hospital, Buraidah, Kingdom of Saudi Arabia. Patients and methods: Sixty two patients with acute coronary syndrome (ACS) were divided into 2 groups according to ECG: group1 with elevated ST segment in ECG (STE-ACS) and group 2 with non elevated ST segment (NSTE-ACS). Twenty healthy subjects with matched age and sex were enrolled as control group in this study. In the sera of all subjects, levels of NT –proBNP, creatine kinase (CK)-MB isozyme and troponin T (Tn-T), were measured by different kits. Results: CK-MB and Tn-T were both significantly higher in STE-ACS patients as compared to NSTE-ACS patients. Conversely, NT-proBNP was significantly higher in NSTE-ACS patients than STE-ACS especially within 4 hours from onset of chest pain. This suggested a larger ischemic insult despite the smaller extent of myocardial necrosis compared with STE-ACS patients. Comparison between sensitivity and specificity of NT-proBNP, Tn-T and CK-MB levels by ROC curves revealed marked difference of area under the curves with higher sensitivity and specificity of NT-proBNP in NSTE-ACS patients. Conclusions: NT-proBNP can serve as a sensitive marker in the early phase of NSTE-ACS patients as compared to conventional markers of myocardial damage. Subject category: Clinical Biochemistry