Predictive value of NT-proBNP in predicting myocardial infarction in patients presenting to the emergency department with chest pain

Acute coronary syndrome (ACS) is a leading cause of mortality worldwide, accounting for 17.9 million deaths annually, according to World Health Organization (WHO) estimates, with one-third of these deaths occurring prematurely in individuals under 70 years of age. Hospital management of acute coronary syndrome (ACS) is a time-critical cardiovascular emergency requiring a multidisciplinary, protocol-based approach. The hospitalization process is structured around early diagnosis, hemodynamic stabilization, selection of an appropriate reperfusion strategy, and prevention of complications. Clinical, laboratory, and ECG are the cornerstones of ACS diagnosis. Creatine kinase and troponin are widely used laboratory values. This study aims to investigate the predictive value of NT-proBNP in predicting MI in patients presenting with chest pain to the Gaziosmanpaşa University Emergency Department in Tokat. The study was designed as a descriptive, retrospective study. Two separate groups, namely patient and control groups, were selected from among patients presenting to the Gaziosmanpaşa University Emergency Department with complaints of chest pain between January 1, 2019, and January 1, 2024. Patients diagnosed with acute myocardial infarction (AMI) and those with cardiac enzymes and NT-proBNP were selected as the patient group, while healthy individuals presenting with chest pain and those with cardiac enzymes and NT-proBNP were selected as the control group. The follow-up cases were analyzed retrospectively. Patients with troponin values of 100 and above were included in the study. Descriptive analyses were conducted to provide information about the general characteristics of the study groups. Data for continuous variables are presented as mean±standard deviation, and data for categorical variables are presented as n (%). The Significance Test for the Difference Between Two Means and One-Way Analysis of Variance are used to compare the means of normally distributed quantitative variables between groups. The Mann-Whitney U test and Kruskal-Wallis test are used to compare the distributions of non-normally distributed quantitative variables between groups. Cross-tabulations and the Pearson chi-square test are used to assess the relationship between qualitative variables. The Spearman correlation coefficient was used for correlations between quantitative variables. P values less than 0.05 were considered statistically significant. Ready-made statistical software was used for calculations (SPSS 22.0 Chicago, IL, USA). Sociodemographic data (age, gender, etc.), ICD 10 diagnoses, cardiac enzymes (mass CK MB, troponin, etc.), NT-proBNP, and blood parameters (Hgb, Plt, MPV, N/L, Plt/L ratios, etc.) were analyzed. A total of 405 patients who presented with a diagnosis of acute coronary syndrome (ACS) and whose coronary pathology was confirmed by angiography were included in our study. 63% (255) of the cases were male and 37% (150) were female. When Pro-BNP values were compared, they were significantly higher in those with RCA+CX lesions compared to RCA and CX (p < 0.05). NT-proBNP values were found to be 5176 (1494-13678) higher in women than in men (2505 (569.8-11064) (p < 0.05). There was a positive correlation between PRO-BNP and TROPONIN and it was statistically significant (p < 0.001). In our study, 63% of stroke patients were male and 37% were female. Hypertension was the most common risk factor in patients diagnosed with ACS in our study. Of the 405 patients diagnosed with ACS included in the study, no coronary artery pathology was detected in 19.5% (79). Among single-vessel pathologies, the most common was LAD lesion in 23.5% (95), while the least was CXR lesion in 13.6% (55). RCA+CXR occlusion was detected in 10.9% (44), and the proportion of patients with multiple vessel occlusions was 18.0% (73). No comorbidities were detected in 1.5% of the total patients. Hypertension alone was detected in 7.7%, CAD in 16.3%, HT+CAD in 25.9%, HT+DM in 9.1%, HT+DM+CAD in 13.8%, and others in 25.7%. When Pro-BNP values were compared, they were significantly higher in those with RCA+CX lesions compared to RCA and CX lesions. In ACS, creatinine values were higher in those with LAD lesions compared to those with RCA occlusions. CK-MB mass was lower in those without lesions compared to those with RCA and multiple vessel occlusions. The CRP/LYM ratio was higher in those without coronary lesions compared to those with LAD, RCA, and CX lesions. The troponin/creatinine ratio was higher in those with RCA+CX lesions compared to those with multiple vessel occlusions. CRP was higher in those without lesions compared to those with LAD, RCA, and CX occlusions. Pro-BNP values were higher in women at 5176 (1494-13678) and in men at 2505 (569.8-11064). A relationship was found between Pro-BNP and troponin, age, MPV, PDW, P-LCR, RDW –SD, calcium, neutrophil, creatinine, CK –MB mass, NE / LYM, PLT / LYM, CRP / LYM, TROP / KREA, WBC, eosinophil and basophil.