Very Long-Term Prognostic Role of Admission BNP in Non-ST Segment Elevation Acute Coronary Syndrome

Abstract

BackgroundBNP has been extensively evaluated to determine short- and intermediate-term prognosis in patients with acute coronary syndrome, but its role in long-term mortality is not known.ObjectiveTo determine the very long-term prognostic role of B-type natriuretic peptide (BNP) for all-cause mortality in patients with non-ST segment elevation acute coronary syndrome (NSTEACS).MethodsA cohort of 224 consecutive patients with NSTEACS, prospectively seen in the Emergency Department, had BNP measured on arrival to establish prognosis, and underwent a median 9.34-year follow-up for all-cause mortality.ResultsUnstable angina was diagnosed in 52.2%, and non-ST segment elevation myocardial infarction, in 47.8%. Median admission BNP was 81.9 pg/mL (IQ range = 22.2; 225) and mortality rate was correlated with increasing BNP quartiles: 14.3; 16.1; 48.2; and 73.2% (p < 0.0001). ROC curve disclosed 100 pg/mL as the best BNP cut-off value for mortality prediction (area under the curve = 0.789, 95% CI= 0.723-0.854), being a strong predictor of late mortality: BNP < 100 = 17.3% vs. BNP ≥ 100 = 65.0%, RR = 3.76 (95% CI = 2.49-5.63, p < 0.001). On logistic regression analysis, age >72 years (OR = 3.79, 95% CI = 1.62-8.86, p = 0.002), BNP ≥ 100 pg/mL (OR = 6.24, 95% CI = 2.95-13.23, p < 0.001) and estimated glomerular filtration rate (OR = 0.98, 95% CI = 0.97-0.99, p = 0.049) were independent late-mortality predictors.ConclusionsBNP measured at hospital admission in patients with NSTEACS is a strong, independent predictor of very long-term all-cause mortality. This study allows raising the hypothesis that BNP should be measured in all patients with NSTEACS at the index event for long-term risk stratification.

Valor Prognóstico do NT-proBNP versus Classificação de Killip em Pacientes com Síndromes Coronarianas Agudas

“…Três estudos têm conclusões positivas em relação ao valor prognóstico desse tipo de marcador; entretanto, esses estudos avaliaram o valor preditivo independente, mas não testaram o valor incremental (discriminação ou reclassificação). [18][19][20][21][22] Nesse contexto, nossos resultados não são discordantes. No entanto, nossa conclusão negativa reside em uma análise mais abrangente que não foi feita anteriormente.…”

ASSOCIATION OF A LYMPHOTOXIN-α VARIABLE SITE rs1041981 WITH DEVELOPMENT OF LONG-TERM UNFAVORABLE OUTCOMES IN PATIENTS WITH ACUTE CORONARY SYNDROME WITHOUT ST-SEGMENT ELEVATION

“…Частота развития неблагоприятных кардио-васкулярных событий за пятилетний период наблюдения у больных ОКСбпST в нашем ис-следовании была сопоставима с таковой в евро-пейских исследованиях [3,15,18]. Наряду с таки-ми известными предикторами неблагоприятного прогноза как старший возраст, ПИКС, высокий балл по шкале GRACE и сниженная ФВ ЛЖ в на-шем исследовании определена неблагоприятная роль генотипа А/А вариабельного сайта rs1041981 гена LTA в отношении развития неблагоприятно-го исхода в течение пяти лет наблюдения после индексного ОКС.…”

Natriuretic Peptides in Clinical Practice

“…In a report which investigated the "very long-term" prognostic value of NT-proBNP in 224 NSTE ACS cases, NT-proBNP on admission was an independent determinant of total mortality at a median follow-up of 9.34 years;a level > 100 pg/mL was associated with a 6.24 fold increased risk (214).…”

“…It was reported that NT-proBNP of 100 pg/mL or above on admission for NSTE ACS was associated with 6.24 times increased total mortality at an approximately ten-years long follow-up (214).…”