Acil Serviste Akut Koroner Sendrom Tanısı Alan Hastalarda Ölçülen BNP Düzeyi İle Mortalite Arasındaki İlişki

Abstract

Yuca N, The Relationship Between BNP Level and Mortality in Patients Diagnosed with Acute Coronary Syndrome in the Emergency Department, Hacettepe University Faculty of Medicine, Thesis of Emergency Medicine. Ankara, 2022. We aimed to investigate the effects of BNP levels on mortality rates at different times in acute coronary syndrome (ACS) patients who applied to the emergency department, and it was planned that the results would contribute to the emergency and long-term treatment strategies of ACS patients. In this single-center retrospective observational study, the data of 582 patients applied to the Adult ED of Hacettepe University between January 01, 2015 and December 31, 2019, who were diagnosed with ACS and whose BNP values were checked were analyzed. 76.6% (n=446) of the patients were male, and the mean age was 62 ±12.6 (min.28, max. 93). It was observed that the hospital, 6th month and 1st year mortality rates and average age were higher in women. While no relationship was found between comorbidities and hospital mortality; HT, DM, CAD, and CKD had significantly higher 1-year mortality rates. It was determined that the 1st year mortality rate was significantly higher in regular smokers, and the BNP level was found to be the lowest in regular smokers. In-hospital and 1st-month mortality rates were higher in STEMI patients than other ACS groups. Still, there was no significant difference between ACS diagnosis groups in 6th-month and 1st-year mortality rates. The BNP levels were found to be highest in the NSTEMI group. The strongest correlation with BNP was seen for the GRACE 2.0 score. In each of the in-hospital, 1st month, 6th-month, and 1st-year mortality analyses, the admission BNP levels of patients who died were found to be significantly higher than those who survived. In the ROC curve calculated for the hospital mortality, with a sensitivity of 73.3% and a selectivity of 76.1%, a value of 311.1 pg/ml was accepted as the ideal admission BNP cut-off value (95% CI=0.68-0.85). It shows that the risk of in-hospital mortality is 8.75 times higher in those with a BNP above 311.1 pg/ml at admission (95% CI=4.6-15.8). These findings support the hypothesis that BNP levels measured in the emergency room in ACS patients can be used to predict in-hospital and short-term mortality. The high BNP value at the first presentation of NSTEMI and USAP patients can be used as a marker to suggest that early invasive treatment will be needed.

Keywords: Emergency Medicine, BNP, Acute Coronary Syndrome, Mortality