To estimate the serum level of N-terminal pro-brain natriuretic peptide levels in acute coronary syndrome

Background: Acute coronary syndromes caused by a sudden blockage of a coronary artery. According to degree and location of the blockage, it ranges from unstable angina to non–ST-segment elevation myocardial infarction (NSTEMI), ST-segment elevation myocardial infarction (STEMI), and sudden cardiac death. The levels of serum cardiac markers get elevated during myocardial necrosis in ACS. B-type natriuretic peptide (BNP), cardiac neurohormone, and its N-terminal fragment (NT-proBNP) are synthesized and secreted from the ventricular myocardium. It is well known that the stimulus for their release is the increase in left ventricular wall stress. Aim and objectives: To estimate the serum level of N-terminal pro-Brain natriuretic peptide levels in acute coronary syndrome, to assess the levels of NT-pro-BNP and its relationship between STEMI, NSTEMI and Unstable angina patients. Materials and methods: The study included 40 patients admitted in the medicine ward of RMMCH. The study period was from January 2018- July 2018. Patients with acute coronary syndromes were identified over a period according to the criteria and were included in the study. The patients were completely evaluated and their serum NT-pro BNP levels were noted. Killips Class was recorded if the patient was in acute MI. In NSTEMI, STEMI and unstable angina, TIMI scoring was also calculated. Results: The common age of the patients was 51 to 60 years (50%). In the age group of 41 to 50 years, 30% was observed. In the age category of 31 to 40 years, 20% was observed. The mean age was 49.10 years. There was 55% of patients with NT pro BNP > 500 in the age category 51-60 years whereas only 16.7% in this range in the age category 41 to 50 years and again only 8% in the age category 30 to 40 years. The Majority of 30 to 40 years had NT pro-BNP of 100 to 500 (62.5%). In the age category of 41 to 50 years, 50% had NT Pro BNP of 100 to 500 while only 35% was in this range in the age group of 51-60 years. In the age category of 41 to 50 years, 33.3% had NT pro-BNP of < 100 whereas only 10% of 51 to 60 years had NT pro-BNP of < 100 and in the age category of 30 to 40 years, no one had NT pro-BNP of <100. The chi-square test of association was insignificant. Cardiac enzymes (Troponin T and CKMB) was elevated for the majority of the patients (N=27, 67.5%). Cardiac enzymes (Troponin T and CKMB) were normal for only 32.5% of the patients. The correlation of TIMI score with NT pro-BNP was peak positive i.e. if NT pro-BNP is higher, TIMI score was also higher and vice versa but the correlation was insignificant (r=2.54, p = .64). Conclusion: Even though the study is done in patients without clinical signs of heart failure, the levels of NT-proBNP had an inverse relationship with Ejection Fraction. Low NT-proBNP levels at the time of admission rule out high-risk patients or patients with heart failure.