Patterns and Implications of B-Type Natriuretic Peptide Measurement in Patients With Non-ST-Segment Elevation Acute Coronary Syndromes^††Conflicts of interest: L. Kristin Newby receives research grants from Millennium Pharmaceuticals, Inc., Cambridge, Massachusetts, the Schering Plough Research Institute ...

FULL TITLE: Patterns and Implications of B-Type Natriuretic Peptide Measurement in Patients With Non-ST-Segment Elevation Acute Coronary Syndromes^††Conflicts of interest: L. Kristin Newby receives research grants from Millennium Pharmaceuticals, Inc., Cambridge, Massachusetts, the Schering Plough Research Institute, and BMS/Sanofi and is a member of the speakers bureau and receives honoraria from BMS/Sanofi/Aventis. W. Frank Peacock receives research grants from and is a member of the speakers bureau and the consultant/advisory board for Millennium Pharmaceuticals, Inc. W. Brian Gibler receives research grants from Millennium Pharmaceuticals, Inc., the Schering Corporation, and the Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership. E. Magnus Ohman receives research grants from Millennium Pharmaceuticals, Inc., the Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership, the Schering Corporation, and Berlex. Eric D. Peterson receives research grants from Bristol-Myers Squibb, the Bristol-Myers Squibb/Sanofi-Aventis Pharmaceuticals Partnership, Bristol-Myers Squibb/Merck, and the Schering-Plough Corporation. Matthew T. Roe is a member of the speakers bureaus for Millennium Pharmaceuticals, Inc., the Bristol-Myers Squibb/Sanofi-Aventis Pharmaceuticals Partnership, and the Schering Corporation and receives research grants from Millennium Pharmaceuticals, Inc., the Bristol-Myers Squibb/Sanofi-Aventis Pharmaceuticals Partnership, and Schering Corporation. Elevated B-type natriuretic peptide (BNP) levels are associated with increased risk for mortality in patients with non-ST-segment-elevation (NSTE) acute coronary syndromes (ACS). However, the optimal use of BNP measurement for the risk stratification of these patients remains unclear. This study was conducted to analyze patterns of, and factors associated with, BNP measurement in patients with NSTE ACS from the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the American College of Cardiology/American Heart Association Guidelines? (CRUSADE) quality improvement initiative from 2003 through 2006. The association of degree of BNP elevation with in-hospital mortality in patients with measured BNP levels across risk categories was also analyzed. A total of 16,323 of 77,071 patients (21.2%) from 486 hospitals had BNP levels measured; the rate of BNP measurement by quarter increased from 5.1% to 27.7% during this analysis. Factors most strongly associated with BNP measurement included signs of heart failure on presentation, older age, previous heart failure, faster presenting heart rate, and higher body mass index. The adjusted risk for mortality was higher in patients who had BNP levels measured than in those who did not (adjusted odds ratio 1.14, 95% confidence interval 1.03 to 1.25). In patients with BNP levels measured, a higher degree of BNP elevation was associated with incrementally higher in-hospital mortality rates across risk categories. BNP levels were measured in approximately 1/5 of patients with NSTE ACS in contemporary practice. BNP was most frequently measured in patients presenting with high-risk characteristics, but the association of incremental increases in BNP levels with higher mortality rates was similar across risk categories. In conclusion, more widespread measurement of BNP levels for risk stratification of patients with NSTE ACS may be warranted.