QJM Advance Access originally published online on October 27, 2007
QJM 2007 100(12):779-783; doi:10.1093/qjmed/hcm098
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Brain natriuretic peptide testing for angina in a rapid-access chest pain clinic
From the 1Cardiovascular Medicine, Charing Cross Hospital, Hammersmith Hospitals NHS Trust, London, 2Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London and 3University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
Address correspondence to Dr S.B. Connolly, Cardiovascular Medicine, 5th Floor, Charing Cross Hospital, Fulham Palace Road, London W6 8RF. email: s.connolly{at}imperial.ac.uk
Received 12 April 2007 and in revised form 27 July 2007
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Abstract |
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Background: Patients complaining of chest pain are frequently referred to secondary care, although the majority have pain of non-cardiac origin.
Aim: To investigate whether B-type natriuretic peptide (BNP) levels are predictive of a diagnosis of non-cardiac pain.
Design: Cross-sectional study.
Methods: Consecutive patients (n = 296) presenting to a rapid-access chest pain clinic (RACPC) received the usual clinical assessment plus near-patient BNP testing, with the assessor blinded to the result. After clinical assessment (including exercise stress testing if clinically indicated), pain was diagnosed likely/definitely cardiac or non-cardiac.
Results: Median BNP was higher in those diagnosed with likely/definite cardiac chest pain (26.5 vs. 8 pg/ml) (p < 0.0001, Wilcoxon rank sum test). The odds ratio for cardiac pain in those with BNP <20 pg/ml was 0.25 (95%CI 0.14–0.47) (p < 0.0005); adjusting for age and sex reduced this to 0.41 (95%CI 0.20–0.83) (p = 0.01). The area under the curve (AUC) for the model including BNP, age and sex was 0.70. With BNP as a continuous variable, the AUC for the same model was 0.72.
Discussion: In typical patients presenting to a RACPC, those with a BNP 
20 pg/ml were significantly less likely to be diagnosed with cardiac pain. Near-patient BNP testing may have a role as a 'rule out test' for angina in patients presenting to a RACPC.