血浆N末端B型利钠肽原对急性冠脉综合征患者近期预后的预测价值（英文）

目的：评价血浆N末端B型利钠肽原（NT-proBNP）对急性冠脉综合征（ACS）患者近期预后的预测价值。方法：连续检测600例住院的ACS患者的血浆NT-proBNP浓度。依据住院期间患者有无心血管事件（心源性死亡、心源性休克、充血性心力衰竭）分为事件组（108例）和无事件组（n=492例）,比较两组NT-proBNP水平,并用回归分析法判断血浆NT-proBNP是否为ACS患者近期心血管事件的独立预测因素。结果：事件组血浆NT-proBNP浓度显著高于无事件组[1361.2（965.3,2088.6）pmol/L比605.7（274.5,1177.8）pmol/L,P〈0.01]。Lo-gistic多元逐步回归分析表明,血浆NT-proBNP是ACS患者近期发生心血管事件的独立预测因素（OR=1.000,P=0.000）。结论：入院时血浆N末端B型利钠肽原是急性冠脉综合征患者近期预后的独立预测因素。     

血浆N末端B型利钠肽原对预测心力衰竭患者住院病死率的价值

目的 评价入院时血浆N末端B型利钠肽原(NT-proBNP)在预测失代偿心力衰竭(心衰)患者住院病死率中的价值.方法 连续检测804例住院的失代偿心衰患者入院时的血浆NT-proBNP浓度.通过ROC曲线下面积评价血浆NT-proBNP浓度在判断心衰患者住院死亡中的价值并找出其切点.应用单因素和多元回归分析判断血浆NT-proBNP是否为心衰患者住院死亡的独立预测因素.结果 804例心衰患者中有64例住院期间死亡,死亡组血浆NT-proBNP浓度显著高于存活组[中位数(第25百分位数,第75百分位数)分别为4321.1(3063.8,6606.5)pmol/L与1921.6(873.9,3739.2)pmol/L,P＜0.01].血浆NT-proBNP判断住院死亡的ROC曲线下面积是0.772(95%CI:0.718～0.825,P＜0.01),根据ROC曲线,将NT-proBNP判断住院死亡的切点值定为3500pmol/L,大于或等于此值时预测死亡的敏感性、特异性和准确性分别是70.3%、72.0%和71.9%,阳性预测值和阴性预测值分别为17.8%和96.6%.大于此值者的住院病死率(17.8%)是小于此值者(3.4%)的5倍(P＜0.01).回归分析表明,血浆NT-proBNP是失代偿心衰患者住院死亡的独立预测因素(P＜0.01).结论 入院时血浆NT-proBNP是急性失代偿心衰患者住院死亡的独立预测因素.以3500 pmol/L为切点,预测住院死亡的敏感性、特异性和准确性均超过70%,阴性预测值高达96.6%.     

血浆NT-proBNP水平对冠心病无症状心脏舒张功能减退的评估

目的评估血浆NT-proBNP水平对于射血分数正常的冠心病患者出现无症状舒张功能减退的预测价值。方法筛选2009年6月至12月期间于北京大学第一医院心内科住院的确诊心肌梗死或经冠状动脉造影证实的冠心病患者,排除左室射血分数减低者（LVEF〈50%）及有心力衰竭症状者,入选253例患者,结合常规超声心动图及组织多普勒结果将患者分为心室舒张功能正常组（115例）及心室舒张功能减退组（138例）。对比两组血浆NT-proBNP水平并分析其对心室功能减退的预测价值。结果心室舒张功能减退组NT-proBNP水平高于心室舒张功能正常组（中位数175.4ng/L,范围8.64～5970ng/L比中位数84.7ng/L,范围5.69～3250ng/L,P〈0.01）,经logistic回归分析,NT-proBNP水平是心室舒张功能减退的独立预测因子（对数转换后,OR=2.78,95%CI1.43～5.40,P〈0.01）,应用NT-proBNP水平诊断心室舒张功能减退的ROC曲线下面积为0.67（95%CI0.60～0.73,P〈0.01）,以NT-proBNP〉119.15ng/L作为截点时敏感性为64%,特异性为62%。结论血浆NT-proBNP水平升高是射血分数正常的冠心病患者出现无症状心室舒张功能减退的独立预测指标。     

收缩性心衰急性失代偿期患者血浆NTpro-BNP水平变化及其对预后的评估

目的探讨血浆N末端B型利钠肽原(NT-proBNP)对收缩功能不全性心力衰竭(SHF)急性失代偿期患者预后的临床评估价值。方法选取该院148例SHF急性失代偿期患者为研究对象进行回顾性分析。根据随访期患者转归分为:研究组,发生心脏事件,共73例;对照组,未发生心脏事件,共75例。比较两组的NT-proBNP水平、左室舒张末期内径(LVEDd)、左室射血分数(LVEF)、再入院率与死亡率。结果与对照组相比,研究组的NT-proBNP、LVEDd、再入院率与死亡率均显著升高(均P<0.05);而LVEF明显降低。多元Logistic回归分析显示,NT-proBNP为远期心脏事件的独立预测因子。NT-proBNP预测心源性死亡ROC曲线下面积为0.792。NT-proBNP取值3 600 pmol/L预测心源性死亡的敏感度和特异度达最高。血浆BNP≤3 600 pmol/L患者生存率高于BNP>3 600 pmol/L(P<0.05)者。结论 NT-proBNP是影响SHF急性失代偿期患者预后的独立预测因素。     

慢性充血性心衰患者血浆NT-proBNP水平与左室重构及房颤的关系

目的探讨慢性充血性心衰（CHF）患者血浆N-末端脑钠肽（NT-proBNP）水平与左室重构及房颤的关系。方法选择CHF患者116例（CHF组）,心功能NYHA分级Ⅱ～Ⅳ级;另选30例健康者作为对照组。检测两组血浆NT-proBNP;采用超声心动图检测其左室射血分数（LVEF）、左室质量指数（LVMI）、左室舒张末期内径指数（LVIDdI）、E/A值。结果 CHF组血浆NT-proBNP、LVMI、LVIDdI均高于对照组（P均〈0.01）,且心功能Ⅳ级者高于Ⅲ级者、Ⅲ级者高于Ⅱ级者（P〈0.01或〈0.05）。CHF合并房颤者的血浆NT-proBNP高于无房颤者（P〈0.05）;与左房内径≤39 mm者比较,左房内径≥40 mm者的房颤发生例数多、血浆NT-proBNP水平较高（P均〈0.01）。多元线性回归分析显示,年龄、房颤、LVMI、LVEF是血浆NT-proBNP升高的独立预测因素（P均〈0.01）。结论 NT-proBNP水平与CHF程度及左室重构相关,慢性CHF合并房颤患者的血浆NT-proBNP明显升高。     

血浆NT-proBNP评估舒张性心衰合并糖尿病患者预后的价值

目的：探讨血浆 N末端B型利钠肽原（NT-proBNP）评估舒张功能不全性心力衰竭（DHF）合并2型糖尿病（T2DM）患者预后的价值。方法：回顾性分析我院206例住院的 DHF合并 T2DM患者资料,依据转归结局不同分为：无事件组108例,事件组98例[发生主要心血事件（MACE）]。检测并比较两组患者住院期间 NT-proB-NP、糖化血红蛋白（HbA1c）、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）水平以及左室舒张末期内径（LVEDd）、左室舒张早期/舒张晚期峰值流速（E/A）比值、左室射血分数（LVEF）值。结果：与无事件组相比,事件组的 NT-proBNP、LVEDd显著增加,LVEF、E/A比值明显降低（P 均＜0.05）,单因素直线分析显示 NT-proBNP、HbA1c、LVEDd、E/A比值与 MACE发生率呈正相关（r＝0.075～0.091,P均＜0.05）,多元 Logistic回归分析显示,NT-proBNP为 MACE的独立预测因子（OR＝1.003,P＝0.009）。NT-proBNP预测患者住院死亡的 ROC曲线下面积为0.803（P＜0.05）,血浆 NT-proBNP≤4010pg/ml者的生存率明显高于 NT-proBNP＞4010 pg/ml者（OR＝5.028,P＜0.05）。结论：血浆 N末端 B型利钠肽原能独立预测舒张功能不全性心力衰竭合并2型糖尿病患者的预后。     

血浆氨基末端脑钠肽前体对NSTEMI患者预后评估的价值

目的：探讨血浆N末端B型利钠肽原（NT-proBNP）评估非ST段抬高性心肌梗死（NsTEMI）患者预后的价值。方法：回顾性分析我院96例住院的NSTEMI患者的临床及随访资料,依据转归结局分为：无事件组（46例）,未发生主要不良心血管事件（MAcE）。事件组（50例）：发生MACE。检测并比较两组患者住院期间NT—proBNP、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL—C）水平以及左室舒张末期内径（LVEDd）、二尖瓣舒张早期／晚期的最大血流速度比（E／A）、左室射血分数（LVEF）。应用单因素直线分析及多元Logistic回归分析患者MACE发生率相关因素,应用ROC曲线分析NT-proBNP的最佳预测值。结果：与无事件组相比,事件组的NT—proBNP[（3157．5±102．4）pmol／L比（4309．6±214．6）pmol／L]、LVEDd[（58．1±5．5）mm比（74．3±6．8）mm]显著升高,LVEF[（71．8±4．1）％比（49．5±3．9）％]、E／A比值[（o．84±0．18）比（O．62±0．12）]明显降低（P均〈0．05）,而TC、LDL-C水平无显著差异（P均〉0．05）。多元Logistic回归分析显示。NT—proBNP为MACE的独立预测因子（OR=1．003,P=0．009）。血浆NT—proBNP≤4390pmol／L者的生存率高于NT-proBNP〉4390pmol／L（0R=5．028,P=0．021）。结论：血浆N末端B型利钠肽原能独立预测非ST段抬高性心肌梗死患者的预后。     

心型脂肪酸结合蛋白对急性肺栓塞患者早期诊断及预后的价值王晓华 刘树琴 金跃 王英丽简

目的 探讨心型脂肪酸结合蛋白对急性肺栓塞患者早期诊断及预后的价值.方法 选取72例急性肺栓塞的患者作为研究组,同期门诊体检健康者30例作为对照组,比较两组及研究组治疗前后血浆心型脂肪酸结合蛋白（H-FABP）和B型脑钠肽前体（NT-proBNP）水平.结果 研究组血浆H-FABP、NT-proBNP明显高于对照组（P〈0.01）.治疗后研究组患者血浆H-FABP、NT-proBNP水平明显降低（P〈0.05）.存活组治疗前血浆H-FABP、NT-proBNP明显低于死亡组（P〈0.01）.结论急性肺栓塞患者血浆H-FABP浓度明显升高,检测血浆H-FABP有助于急性肺栓塞的早期诊断和预后判断.     

N末端B型钠尿肽前体对高龄急性冠状动脉综合征患者预后评估的价值

目的探讨血浆N末端B型钠尿肽前体(NT-proBNP)对高龄急性冠状动脉综合征(ACS)患者病情及预后评估的价值。方法回顾性选择2011年1月～2016年1月中国医学科学院阜外医院因ACS住院治疗的高龄患者338例,根据NT-proBNP水平分为高水平组84例(NT-proBNP≥1228.7 ng/L)和低水平组(NT-proBNP1228.7 ng/L)254例。检测基线NT-proBNP水平,计算全球急性冠状动脉事件注册(GRACE)评分。观察出院后1年及长期随访期间主要不良心血管事件(MACE)发生情况。结果高水平组NT-proBNP、GRACE评分、GRACE评分高危比例明显高于低水平组,差异有统计学意义(P0.01)。Spearman相关性分析显示,NT-proBNP水平与高龄ACS患者GRACE评分呈正相关(r=0.341,P0.01)。ROC曲线分析显示,NT-proBNP能预测高龄ACS患者短期和长期MACE风险(P0.05,P0.01)。短期随访中发生MACE 24例(7.4%),长期随访中发生MACE 152例(49.2%)。Kaplan-Meier生存曲线显示,高水平组短期及长期随访MACE累积发生率明显高于低水平组,差异有统计学意义(P_(log rank)0.01)。多因素Cox回归分析显示,调整相关因素后,高水平NT-proBNP与高龄ACS患者短期及长期随访MACE发生风险独立相关(HR=2.841,95%CI:1.172～6.884,P=0.021;HR=1.653,95%CI:1.138～2.399,P=0.008)。结论高水平NT-proBNP是高龄ACS患者短期及长期MACE的独立预测因素。     

高敏C反应蛋白与急性冠脉综合征的相关性

目的：探讨高敏C反应蛋白（hsCRP）与急性冠脉综合征（ACS）病变严重程度及预后之间的关系。方法：选择95例ACS患者,其中急性心肌梗塞（AMI）50例、不稳定型心绞痛（UAP）45例,并根据冠脉病变程度分单支血管病变（SVL）组48例和多支血管病变（MVL）组47例。另选40例非ACS患者作为非ACS对照组,测定各组hsCRP、纤维蛋白原、血脂等指标,进行比较。结果：与非ACS对照组比较,UAP组、AMI组hsCRP水平明显升高[（0.85±0.49）mg/L比（10.01±1.73）mg/L比（52.73±2.39）mg/L,P〈0.01],AMI组明显高于UAP组（P〈0.01）;MVL组hsCRP水平明显高于SVL组[（69.11±1.98）mg/L比（10.12±2.01）mg/L,P〈0.05]。Spearman相关分析显示,hsCRP与冠脉狭窄呈正相关（r=0.210,P=0.042）,与纤维蛋白原（r=0.516,P〈0.0001）、血脂水平呈明显正相关（r=0.100～0.159,P〈0.001～〈0.0001）。结论：高敏C反应蛋白与冠脉病变严重程度呈正相关,是冠心病的独立危险因素;测定高敏C反应蛋白水平对急性冠脉综合征的危险分层和预测病变严重程度具有较高的临床参考价值。     

急性冠状动脉综合征病人治疗前后血浆脑钠肽N末端前体水平

目的观察急性冠状动脉综合征病人血浆脑钠肽N末端前体（N-terminal pro—brain natrluretic peptide,NT—proBNP）水平变化,评价该指标在急性冠状动脉综合征病人治疗中的临床意义。方法急性冠状动脉综合征病人60例（冠心病急性心肌梗死29例,不稳定型心绞痛31例）,稳定性心绞痛33例,正常对照28例。采用电化学发光双抗体夹心免疫法分析检测血浆NT—proBNP水平,以超声心动图评价心功能．同时对急性心肌梗死25例经皮冠状动脉介入术前后上述指标进行分析。结果急性冠状动脉综合征组病人血浆NT-proBNP水平为3630ng／L（95％可信区间1412～9332）,明显高于对照组75．8ng／L（95％可信区间40～144）（P〈0．001）,而稳定性心绞痛组与对照组之间差异无统计学差异（P〉0．05）。且25例急性冠状动脉综合征病人在经皮冠状动脉介人术后12～24小时内血浆NT—proBNP水平从术前4732ng／L（95％可信区间为1828～12246）降至344ng／L（95％可信区间为192～616）,差异有统计学意义（P〈0．01）。结论急性冠状动脉综合征病人血浆NT-proBNP含量明显升高,提示NT—proBNP可作为早期评估急性冠状动脉综合征病人的心功能情况。治疗后含量明显降低,可作为观察疗效的一个指标。     

急性冠脉综合征行急诊PCI术后hs-CRP和NT-proBNP的临床意义及其预测价值

目的:观察高敏C反应蛋白(hs-CRP)和氨基末端脑钠尿肽原(NT-proBNP)在急性冠脉综合征(ACS)行急诊冠状动脉介入治疗(PCI)术前后的临床意义及其近期预后的预测价值。方法:选择从2009年2月~2011年4月入住两家医院的ACS患者101例,均已成功行急诊PCI术,术后24 h、72 h~7 d、3~6个月测定血清hs-CRP和NT-proBNP水平;并观察随访3~6个月的主要心脏不良事件(MACE)。同时观察ACS药物治疗组52例,健康对照组40例,并进行对比分析。结果:药物治疗组的近期血清NT-proBNP水平显著高于PCI组;而药物治疗组的72 h~7d的血清hs-CRP水平显著高于PCI组;近期PCI组的MACE事件低于药物治疗组。结论:急诊PCI组3~6个月内治疗效果优于药物治疗组。血清NT-proBNP能够对ACS患者进行危险分层,预测MACE的发生率;hs-CRP可作为行急诊PCI的ACS患者的近期预后的预测因子。     

N末端脑钠肽及基质金属蛋白酶-9与非ST段抬高急性冠脉综合征的早期心室重构的关系

目的:探讨N末端脑钠肽(NT-proBNP)及基质金属蛋白酶-9(MMP-9)在判断非ST段抬高急性冠脉综合征早期心室重构中的作用及相互关系. 方法:选择连续住院的非ST段抬高急性冠脉综合征患者57例,分为高危组(n=17)、中危组(n=15)及低危组(n=25),并设正常对照组(n=29).冠状动脉造影前抽取股动脉血,测定NT-proBNP及MMP-9浓度.分别于造影前后3天内及造影后10～14天内行超声心动图检查. 结果:各组间NT-proBNP、MMP-9水平及射血分数、左心室质量指数(LVMI)差异具有统计学意义(除射血分数在中危组和低危组之间P>0.05外,其余P均<0.05).在高危组,NT-proBNP与MMP-9呈正相关(r=0.574,P=0.025),NT-proBNP与LVMI呈正相关(r=0.617,P=0.014);MMP-9与射血分数呈负相关(r=-0.542,P=O.025). 结论:联合检测NT-proBNP及MMP-9对判定高危非ST段抬高急性冠脉综合征早期心室重构具有重要意义.     

Incremental prognostic value of C-reactive protein and N-terminal proB-type natriuretic peptide in acute coronary syndrome.

BACKGROUND: Cardiac biomarkers, including high-sensitivity C-reactive protein (hs-CRP), N-terminal proB-type natriuretic peptide (NT-proBNP) and cardiac troponin-I (Tn-I), have been associated with an adverse outcome in patients with acute coronary syndrome (ACS). Thus, in the present study the incremental prognostic value of these cardiac biomarkers was evaluated for risk stratification of ACS. METHODS AND RESULTS: The baseline levels of hs-CRP, NT-proBNP and Tn-I were measured in 215 patients (140 males; 65+/-46 years) with ACS: ST-elevation myocardial infarction (STEMI): 56; non-ST-elevation myocardial infarction (NSTEMI): 98; unstable angina (UA): 61. The patients were retrospectively followed up for a mean of 246 days. There were 24 cardiac events: STEMI: 1, NSTEMI: 6, UA: 6, chronic heart failure: 1, death: 10. The baseline levels of hs-CRP and NT-proBNP were significantly higher in the patients with cardiac events than in those without events. After adjustment for major clinical prognostic factors, hs-CRP and NT-proBNP remained significantly independent predictors for cardiac events. Patients with hs-CRP level >3.5 mg/L and NT-proBNP level >500 pg/ml had an 11-fold higher risk for cardiac events than those with hs-CRP level 相似文献   

NT-ProBNP serum levels reflect severity and extent of ischemia in patients admitted with non-ST-elevation acute coronary syndrome

OBJECTIVE: To explore the relationship between NT-proBNP elevation and prognosis in patients with NSTEACS. BACKGROUND: High NT-proBNP levels are related to a worse prognosis in patients with ACS. The precise mechanism by which is not clear. METHODS: Serial sampling of NT-proBNP, Troponin T and CK-MB was performed in 23 patients admitted with NSTEACS. Using coronary angiography in each patient a culprit lesion was identified. Proximal lesions were located before or at the first major branch of the parent artery. All other lesions localizations were considered distal. To evaluate the influence of left ventricular systolic function on NT-proBNP levels WMSI was measured by echocardiography. RESULTS: Proximal culprit lesion localization was associated with significant higher baseline (mean 506 ng/l, SD 440 ng/l) and peak NT-proBNP levels (mean 1055 ng/l; SD 236 ng/l), as compared to patients with a distal lesion localization. (Baseline: 139 ng/l, SD 140 ng/l, peak: 381 ng/l; SD 64 ng/l). (P = 0.01) NT-proBNP levels were highly correlated to Troponin T and CK-MB peak serum levels. Adjustments for left ventricular dysfunction did not alter these associations. CONCLUSIONS: High peak NT-proBNP levels are independently associated with both proximal culprit localization and elevated biochemical markers of myocardial damage. These findings suggest that NT-proBNP levels reflect the amount of jeopardized myocardium and could signify the integral of the extent and severity of an ischemic event.     

急性冠脉综合征中不同程度冠脉病变患者血浆N末端脑钠肽原检测及其意义

目的观察急性冠脉综合征（ACS）患者冠脉严重程度与血浆N末端脑钠肽原（NT-proBNP）的相关性,并探讨其临床意义。方法135例经冠状动脉造影证实的冠心病患者,按冠状动脉造影结果分为：单支病变49例,多支病变86例,15例非ACS患者作为对照组。检测ACS患者12h内及其患者入院时的血浆NT-proBNP浓度,同时行冠脉造影明确冠脉病变性质及程度,比较不同组别NT-proBNP的差异以及冠脉造影结果与NT-proBNP的相关性。结果对照组、单支病变、多支病变组,血浆NT-proBNP浓度分别为89.1±76.3、286.3±378.9、1075.3±1743.0pg/mL,ACS各组血浆NT-proBNP均明显高于对照组（P〈0.05）,多支病变组血浆NT-proBNP浓度明显高于单支病变组（P〈0.05）。结论不同ACS冠脉病变程度患者的血浆NT-proBNP浓度存在差异,血浆NT-proBNP浓度与ACS患者冠脉严重程度相关。     

Evaluation of N-terminal prohormone B-type natriuretic Peptide in patients with acute coronary syndromes and percutaneous coronary intervention

The aim of this research was to describe N-terminal part of the prohormone B-type natriuretic peptide (NT-proBNP) levels over time in patients with acute coronary syndrome (ACS) before and after percutaneous coronary intervention (PCI). NT-proBNP, troponin I (Tn-I), creatine kinase (CK), CK MB isoenzyme (CKMB), fibrinogen, D-dimers, and C-reactive protein (CRP) were measured in 300 consecutive patients with ACS before undergoing successful reperfusion with PCI in the first 48 hours, 2 days after, and at the end of the 1st, 3rd, 6th, 12th, 18th, and 24th month. The concentration of NT-proBNP was cross-correlated with the levels of NT-proBNP in 300 patients without ACS and was significantly increased before and after PCI and at the end of the 3rd month, contrasting with the fast conversion to normal levels of Tn-I, CK, CKMB, fibrinogen, D-dimers, and CRP. In patients with ACS undergoing successful PCI, NT-proBNP shows slow kinetics, especially in patients with an increased thrombolysis in myocardial infarction risk score, hypertension, and diabetes. Nevertheless, cardiac neurohormonal activation may be a unifying feature among patients at high risk for cardiovascular events after ACS and PCI.     

急性冠状动脉综合征严重程度与血浆氨基酸N末端脑钠肽原浓度相关性的研究

目的探讨急性冠状动脉综合征（ACS）患者血浆氨基酸N末端脑钠肽原（NT-proBNP）浓度与疾病严重程度是否相关,观察NT—proBNP是否可作为ACS疾病严重程度的客观生化指标。方法入选2003年10月至2004年6月之间,在我院心内科监护室住院的ACS患者（包括不稳定性心绞痛和急性心肌梗死）89例,年龄34—85岁;采集静脉血样的同时对不稳定性心绞痛（UA）患者进行Braunwald分级,对急性心肌梗死患者进行Killip分级;用ELISA方法检测血浆NT-proBNP浓度;用SPSS软件包进行统计学分析。结果ACS患者血浆NT-proBNP浓度与疾病严重程度存在良好的相关性：随着Braunwald分级增高,UA患者血浆NT-proBNP浓度逐渐增高（三级之间及每两级之间的NT-proBNP浓度的差异均有统计学意义,P〈0．05）;随着Killip分级增高,急性心肌梗死患者血浆NT-proBNP浓度也逐渐增高（三级之间以及每两级之间的NT-proBNP浓度差异均有统计学意义,P〈0．05）;而且在NYHA心功能都是Ⅰ级的时候急性心肌梗死患者血浆NT-proBNP浓度高于UA患者（P〈0．05）。结论ACS患者血浆NT-proBNP浓度与疾病的严重程度有一定的相关性,NT-proBNP可能会成为ACS疾病严重程度的生化指标之一。     

Troponin-T and N-terminal pro-B-type natriuretic peptide predict mortality benefit from coronary revascularization in acute coronary syndromes: a GUSTO-IV substudy.

OBJECTIVES: This study was designed to evaluate biomarkers for selection of patients with non-ST-segment elevation acute coronary syndromes (ACS) that derive mortality benefit from revascularization. BACKGROUND: Biomarkers are essential for identification of patients at increased risk, which may be reduced by revascularization. METHODS: During the initial 30 days, 2,340 patients of 7,800 (30%) with non-ST-segment elevation ACS in the GUSTO (Global Utilization of Strategies To open Occluded arteries)-IV trial underwent coronary revascularization. The 1-year mortality was calculated in 30-day survivors stratified by status of revascularization and levels of biomarkers. A propensity score for receiving revascularization was constructed and included in a survival analysis that also included the time point of revascularization as a time-dependent covariate. RESULTS: Elevation of troponin-T or N-terminal pro-B-type natriuretic peptide (NT-proBNP) was associated with a high mortality. In patients with either or both of these markers elevated, a lower mortality following revascularization was observed. In contrast, patients without elevation of these markers had low 1-year mortality without any reduction in mortality following revascularization. In fact, in patients with normal levels of both troponin-T and NT-proBNP, a significant increase in 1-year mortality after revascularization was observed. Elevation of C-reactive protein, interleukin-6, creatinine clearance, and ST-segment depression was also related to a higher mortality. However, independent of these markers, mortality was lower after revascularization. CONCLUSIONS: Markers of troponin-T and NT-proBNP not only assist in risk stratification of patients with non-ST-segment elevation ACS but also appear to identify patients who have a reduced mortality associated with early coronary revascularization.