BNP in acute coronary syndromes: the heart expresses its suffering

The use of N-BNP is well established in the diagnosis and staging of patients with heart failure1 and its ability to predict prognosis in this population has been verified in several frequently cited studies.2 Recently, measure- ment of N-BNP has also been shown to be a useful prognostic tool in the population of patients with ACS.3 In a past issue of this journal, Bazzino et al., further extended our knowledge in that they demonstrated the prognostic value of elevated levels of N-terminal B-type natriuretic peptide (N-BNP) in addition to standardised risk-stratification schemes in patients ðn ¼ 1483Þ that were included consecutively with acute coronary syn- dromes (ACS).4 Risk stratification of patients with ACS Although, early treatment with fibrinolytic agents or percutaneous coronary intervention is well documented in acute ST-elevation myocardial infarction (STEMI), the optimal treatment strategy for the considerable and in- creasing population with non-STEMI is still being devel- oped. These patients have an elevated risk for subsequent cardiac events5 despite substantial progress in management during the last decade. Therefore, risk stratification is important for selection of medical ther- apy and the optimal use of invasive procedures explain- ing the interest in a biomarker potentially identifying the most appropriate target population. Treatment of the patients with the highest risk scores with an early invasive strategy and intensive anticoagu- lation has shown to lower rates of death, myocardial infarction (MI), and re-admission.6;7;8 Various risk-strati- fication algorithms have been developed to identify those patients at highest risk who deserve priority with regard to intensive care and aggressive medical and in- terventional treatment. Commonly employed variables include age >65 years, ST-deviation on ECG,9 known coronary artery disease or previous coronary artery by- pass grafting (CABG), prior use of aspirin and accelerat- ing symptoms.10