Elsevier

American Heart Journal

Volume 262, August 2023, Pages 90-99
American Heart Journal

Clinical Investigations
Prognostic significance of serial N-terminal pro-B-type natriuretic peptide levels in patients with acute myocardial infarction: A prospective study

https://doi.org/10.1016/j.ahj.2023.04.015Get rights and content

Objects

This study aimed to investigate the association between N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels at different sampling times and prognosis in patients with acute myocardial infarction (AMI) undergoing emergency percutaneous coronary intervention (PCI).

Methods and results

Between March 2017 and January 2020, 1,105 patients with AMI who underwent emergency PCI were included. NT-proBNP levels were measured on days 0, 1, 2, 3, and 7. A composite of all-cause death, MI recurrence (reMI), and rehospitalization due to heart failure, known as major adverse cardiovascular events (MACE), was recorded. During the 36.8-month follow-up, 175 patients (15.8%) experienced MACEs. When patients were grouped based on quartiles of NT-proBNP levels on days 0 and 7, the results demonstrated that patients in quartile 4 showed a substantially increased MACE risk compared to those in quartile 1 (hazard ratio [HR] 2.27, 95% confidence interval [CI]:1.27-4.08, P = .006; HR 2.20, 95%CI:1.23-3.94, P = .008). There were U-shaped relationships between the HR for MACE and NT-proBNP levels on days 2, 3, and 7, as well as peak NT-proBNP (P for nonlinearity = .007, .006, .004, and .009, respectively). A similar relationship was observed in the HR for reMI and NT-proBNP levels on days 2 and 3. For MACE at 3 years, serial NT-proBNP levels improved the predictive accuracy of the Global Registry of Acute Coronary Events (GRACE) risk score (concordance index [C-index]: 0.711; continuous net reclassification improvement [NRI]: 0.192, 95% CI: 0.022-0.445; integrated discrimination improvement [IDI]: 0.034, 95% CI: 0.016-0.064). For all-cause death at 3 years, the combination of NT-proBNP and GRACE score showed excellent performance, with C-index, continuous NRI, and IDI values of 0.801, 0.373 (95%CI: 0.072-0.853), and 0.051 (95%CI: 0.025-0.091), respectively.

Conclusions

Early and sequential measurement of NT-proBNP levels could assist in predicting MACE risk. Moreover, the relationship between MACE risk and NT-proBNP levels was U-shaped.

Clinical Trial Registration

clinicaltrials.gov NCT: 03593928

Section snippets

Background

Although substantial progress has been made in reperfusion and pharmacological therapies over the past decades, acute myocardial infarction (AMI) remains the leading cause of mortality worldwide. Some patients with AMI still experience cardiovascular events or death during follow-up.1 Researchers have been searching for more accurate biomarkers to identify patients with AMI at high cardiovascular risk. N-terminal pro-B-type natriuretic peptide (NT-proBNP) is the N-terminal component of the

Population

We prospectively enrolled patients with AMI who underwent emergency PCI and were admitted to Fuwai Hospital between March 2017 and January 2020. AMI was diagnosed according to the Fourth Universal Definition of Myocardial Infarction and current guidelines,10., 11., 12. including elevated troponin I levels and clinical evidence of ischemia. Patients’ information, including demographics, medical history, signs and symptoms, laboratory results, echocardiography data, and medication at discharge,

Characteristics of included patients

In total, 1,105 patients were included in the final analysis. During 36.8 months (interquartile range 36.1-48.8) of follow-up, MACEs occurred in 175 patients (15.8%). In addition, there were 100, 145, and 165 MACE cases during the 1, 2, and 3 years of follow-up, respectively. The characteristics of the patients in the different outcome groups are summarized in Table I. Compared with patients without MACE, those with MACE were more likely to be female and older, had a higher prevalence of

Discussion

This study set out to investigate the prognostic value of sequential NT-proBNP levels during hospitalization in patients with AMI undergoing PCI. Higher NT-proBNP levels were generally associated with an increased risk of MACEs, regardless of the sampling time. Notably, U-shaped relationships were observed between MACE risk and lg-transformed NT-proBNP levels on days 2, 3, and 7. In addition, the combination of sequential NT-proBNP levels and GRACE scores exhibited good performance in

Conclusions

Higher NT-proBNP levels were generally associated with an increased MACE risk in patients with AMI undergoing PCI, regardless of the sampling time. Early and sequential Measurements of NT-proBNP levels could assist in predicting the risk of MACEs. Moreover, the relationship between MACE risk and NT-proBNP levels was U-shaped.

Funding

This study was supported by the National Natural Science Foundation of China (No. 81970308), the Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences (No. 2016-I2M-1-009), the Fund of “Sanming” Project of Medicine in Shenzhen (No. SZSM201911017), and Shenzhen Key Medical Discipline Construction Fund (No. SZXK001).

Author contributions

Conceptualization: NL, HZ and HY; Data curation: XZ, RC, JZ, JL, YW and YC; Formal analysis: NL; Funding acquisition: HY; Investigation: XZ, RC, JZ, JL, YW and YC; Methodology: NL, XZ, RC, HZ and HY; Project administration: HZ and HY; Resources: CL, PZ, HZ, LS, and SY; Software: NL; Supervision: HZ and HY; Validation; Visualization: RC; Roles/Writing - original draft: NL; Writing - review & editing: XZ, RC, JZ, JL, YW, CL, PZ, LS, HZ, HY.

Disclosure

All authors declare no conflicts of interest.

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