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Minerva Cardioangiologica 2020 Jul 10

DOI: 10.23736/S0026-4725.20.05303-7


language: English

Early changes in NT-proBNP levels predict new-onset heart failure in patients with STEMI

Marco G. DEL BUONO 1, 2, Cory R. TRANKLE 1, Leo BUCKLEY 4, Dinesh KADARIYA 1, Justin M. CANADA 1, Salvatore CARBONE 3, Jeremy TURLINGTON 1, Roshanak MARKLEY 1, Edoardo BRESSI 1, Benjamin W. van TASSELL 1, 4, Antonio ABBATE 1, 2

1 Division of Cardiology, Department of Internal Medicine, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA; 2 Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy; 3 Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, Richmond, VA, USA; 4 Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University, Richmond, VA, USA


BACKGROUND: Previous studies suggested that N-terminal pro-Brain natriuretic peptide (NT- proBNP) level is a powerful independent predictor of death or heart failure (HF) when measured at admission in patients with chest pain or acute coronary syndrome. Little is known about the role of NT-proBNP level measured during a hospitalization for ST segment elevation myocardial infarction (STEMI) in predicting clinical outcomes. We evaluated the optimal NT-proBNP timing (admission, 72 hours, or delta [Δ] NT-proBNP [72 hours minus admission]) to predict 1-year new-onset HF in STEMI patients.
METHODS: We measured NT-proBNP levels at admission and 72 hours in 72 patients with STEMI. HF events were adjudicated and defined as hospitalization for HF or need for new initiation of a loop diuretic at 1-year follow-up. Values are presented as medians and interquartile range or frequencies (%) as appropriate. Cox regression analysis was used to determine predictors of adverse events. A receiver-operative-curve was constructed to identify the discriminative value and optimal cut-off points for NT-proBNP.
RESULTS: Patients (age 56 [49-64] years, males 59 [82%]) were followed for a median duration of 365 [180-365] days. HF events were recorded in 9 (12.5%) patients. NT-proBNP values at admission, 72 hours, and ΔNT-proBNP were 89 (26-268) pg/mL, 452 (223-1064) pg/mL, and 283 (68-686) pg/mL, respectively. NT-proBNP at 72 hours and ΔNT-proBNP, but not admission NT- proBNP predicted new-onset HF events at follow-up (p=0.03, p=0.002 and p=0.89, respectively). The optimal area under the curve of 0.771 (95%, CI [0.630-0.912], p= 0.009) and cut-off value of 830 pg/mL (sensitivity 79%; specificity 76%) were found for NT-proBNP at 72 hours. The Kaplan- Meier survival curves for NT-proBNP at 72 hours dichotomized above and below this cut-off value, confirmed NT-proBNP at 72 hours >830 pg/mL as predictive of HF events (log-rank statistic=8.688, p=0.003).
CONCLUSIONS: NT-proBNP level at 72 hours and ΔNT-proBNP (72 hours minus admission), but not at time of admission, predicted HF events in patients following STEMI.

KEY WORDS: STEMI; BNP; Natriuretic peptides; NT-proBNP; Hospitalization; Outcomes

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