Accuracy of N-terminal-pro-atrial natriuretic peptide in patients admitted to emergency department

Objective. B-type natriuretic peptide ( BNP) and N- terminal- pro- BNP ( Nt- proBNP) are commonly used for the triage of patients in the emergency department ( ED) with dyspnoea and/ or chest pain. The aim of our study was to determine the accuracy of N- terminal- pro- ANP ( Nt- proANP) in such patients. Material and methods. NtproANP was measured by home- made radioimmunoassay in 137 ED patients admitted with cardiovascular and/ or pulmonary disorders. BNP and Nt- pro- BNP were determined with automated assays. Final diagnosis was confirmed at discharge or after follow- up. Results. Nt- proANP levels were significantly influenced by the diagnostic subgroups ( ANOVA: pv0.001) and were [ geometric mean ( range)]: 19727 ng/ L ( 5260- 45200) in congestive heart failure ( CHF, n531), 6575 ng/ L ( 1350- 36000) in coronary artery disease ( CAD, n519), 5324 ng/ L ( 1710- 13150) in pulmonary embolism ( PE, n520), 5035 ng/ L ( 1510- 16600) in pulmonary diseases ( PD, n524) and 3001 ng/ L ( 750- 11860) in patients without cardiopulmonary diseases ( n543). Pairwise comparisons demonstrated that CHF patients had Nt- pro- ANP values higher than all other groups ( pv0.05) and that patients without cardiopulmonary diseases had the lowest values ( pv0.05). For diagnosis of CHF, the area under the ROC curve of Nt- proANP was 0.94 ( 95 % CI: 0.89- 0.98) and was equivalent to Nt- proBNP ( 0.91; p50.284) and BNP ( 0.93; p50.572). Conclusions. The diagnostic accuracy of Nt- proANP was equivalent to BNP and Nt- proBNP in the present cohort of patients admitted to ED with dyspnoea and/ or chest pain.