Is Grace Risk Score the Holy Grail in Risk Stratification or Can We Improve it Even Further with Additional Biomarkers?

B-type natriuretic peptide (BNP) has been recognized as a very useful marker for the detection of acute and chronic left ventricular dysfunction, both systolic and diastolic, that can be present in the context of sudden and prolonged myocardial ischemia. ^, These are the first steps in the ischemic cascade, leading to cell necrosis. For that reason, natriuretic peptides are usually elevated in the context of acute coronary syndromes.

Myocardial ischemia, even in the absence of left ventricular dysfunction, augments cardiac BNP gene expression, increasing plasma NT-proBNP concentrations. ^, BNP kinetics usually peaks at 16 hours of symptom’s onset in ST-elevation myocardial infarction and a second peak is usually observed by the fifth day. We can speculate that the first peak might be associated with ischemia and the second peak to left ventricular dysfunction associated with cell necrosis and early remodelling.

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