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The cardiac neurohormone B-type natriuretic peptide (BNP) can predict mortality in patients with acute coronary syndromes, but levels are usually measured within days of the start of symptoms. In this Practice Point Saihari Sadanandan discusses Grabowskiet al.'s study exploring the link between BNP levels on admission for ST-elevation myocardial infarction, short-term mortality and angiographic success.