Association of NT-proBNP and Subsequent Major Adverse Cardiovascular and Cerebral Events in Patients with Successful PCI for ACS and Normal LVEF

Abstract

<jats:title>Abstract</jats:title> <jats:p><jats:bold>Background: </jats:bold>Does N-Terminal pro-brain natriuretic peptide (NT-proBNP) predict subsequent major adverse cardiovascular and cerebral event (MACCE) in patients received successful percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) and had normal left ventricular ejection fraction (LVEF)? <jats:bold>Methods: </jats:bold>3986 ACS patients were divided into 4 groups based on the quartile (Q) values of peak NT-proBNP measured during hospitalization. All patients were followed for MACCE, a composite of all-cause death, non-fatal myocardial infarction (MI) or stroke, and heart failure requiring hospitalization (HFRH), during a median of 35 months. The incidence of MACCE was compared among Q1-Q4. Receiver operation characteristic curves (ROC) were generated to compare the area under the curve (AUC) for MACCE, cardiovascular (CV) death and HFRH by adding NT-proBNP to the TIMI (thrombolysis in myocardial infarction) risk score.<jats:bold>Results: </jats:bold>The incidences of MACCE (5.6%, 9.1%, 13.0%, 20.1%, <jats:italic>P</jats:italic> &lt;0.001), all-cause death (1.0%, 2.5%, 4.1%, 8.4%, <jats:italic>P</jats:italic> &lt;0.001), non-fatal MI (2.0%,3.4%,4.8%,6.2%, <jats:italic>P</jats:italic> &lt;0.001) and HFRH (1.5%, 2.3%, 4.1%, 5.9%, <jats:italic>P</jats:italic> &lt;0.001) were significantly increased from Q1 to Q4, but, not stroke (1.4%, 1.4%, 1.3%, 2.1%, <jats:italic>P </jats:italic>=0.438). Each median level (337pg/ml) increase in NT-proBNP was significantly and independently associated with increased risk of MACCE (HR 1.02, 95%CI, 1.01-1.03; <jats:italic>P</jats:italic> &lt;0.001). Compared with TIMI (thrombolysis in myocardial infarction) risk score alone, TIMI+NT-proBNP showed improved AUCs: CV death (0.76 vs. 0.72, <jats:italic>P </jats:italic>=0.0008), and HFRH (0.68 vs. 0.66, <jats:italic>P</jats:italic> =0.0017), MACCE (0.70 vs. 0.69,<jats:italic> P </jats:italic>=0.0012), respectively.<jats:bold> Conclusion: </jats:bold>NT-proBNP was significantly and independently associated with increased risk of subsequent MACCE in 3 years in ACS patients who received successful PCI and had normal LVEF, and improved the prognosis of major adverse events in addition to the TIMI risk score.</jats:p>