The age, NT-proBNP, and Ejection Fraction Score as a Novel Predictor of Clinical Outcomes in CAD Patients After PCI

Abstract

Background Previous evidences have been proved that age, N-terminal pro-B-type natriuretic peptide (NT-proBNP), and ejection fraction are tightly associated with the long-term outcomes in patients suffered from coronary artery disease (CAD). Therefore, the present study aimed to assess the prognosis value of age, NT-proBNP, and ejection fraction (ABEF) score in CAD patients who underwent percutaneous coronary intervention (PCI). Methods Observational cohort methodology was used in this study which enrolled totally 3561 patients. And the patients were followed up regularly for 37.59 ± 22.24 months. Patients were classed into three groups based on the tertiles of ABEF sore: first tertile (<5.06, n = 831), second tertile (5.06-6.25, n = 839), and third tertile (≥ 6.25, n = 834). The ABEF score was calculated as follows: age (years)/ejection fraction (%) + NT-proBNP (NT-proBNP<177pg/mL was 1, 177≤NT-proBNP≥524pg/mL was 2 and NT-proBNP > 524pg/mL is 3). The association between ABEF score and adverse prognosis, including all-cause death (ACD), cardiac death (CD), major adverse cardiovascular events (MACEs) and major adverse cardiac and cerebrovascular events (MACCEs), in patients who underwent PCI was analyzed. Results According to the risk category of ABEF score, the incidences of ACD ( P < .001), CD ( P < .001) and MACCEs ( P = .021) among the three groups showed significant differences. Multivariate Cox regression analysis suggested that the respective risks of ACD and CD were increased 3.013 folds (hazard risk [HR] = 4.013 [95% confidence interval [CI]: 1.922-8.378], P < .001) and 4.922 folds ([HR] = 5.922 [95% [CI]: 2.253-15.566], P < .001) in the third tertile compared with those in the first tertile. Kaplan-Meier survival analyses showed that the cumulative risks of ACD,CD and MACCEs in patients with the high ABEF score tended to increase. Conclusion The present study indicated ABEF score was a novel biomarker suitable for predicting adverse prognosis in patients after PCI, which may be used for early recognition and risk stratification.

Unstable Angina: Risk Stratification for Significant Coronary Artery Disease in The Era of High-Sensitivity Cardiac Troponin

“…Similarly, a previous study by Fladseth et al [25] reported that 45% of UA patients presented with obstructive CAD, and GRACE score and ESC/ACC guideline risk criteria showed low diagnostic accuracy for CAD, with AUC of 0.59 and 0.58, respectively. Previous clinical studies have reported models for risk stratification of patients with NSTE-ACS, some using one or more biomarkers [6][7][8], others combining biomarkers with echocardiogram or CCTA findings [9,10]. Tello-Montoliu et al [6] included 358 patients admitted for NSTE-ACS and used troponin, NT-proBNP, C-reactive protein (CRP), and D-dimer levels to predict major adverse events.…”

“…Previously, Omland et al [7] described NT-proBNP as a powerful prognostic marker across the ACS spectrum. More recently, a study aimed to assess prognosis using a model with age, NT-proBNP, and ejection fraction (ABEF score) in patients with chronic coronary syndrome, who underwent PCI [9]. The authors found that a higher ABEF score was related to major cardiovascular events.…”

“…Although bedside echocardiogram WMA evaluation is a more time-consuming and subjective assessment than a laboratory workup, there are no known biomarkers capable of properly recognizing significant CAD in patients with chest pain. Furthermore, echo-derived data have been reported to improve risk stratification in ACS [9]. Moreover, Xia et al [10] described that coronary findings on CCTA (lesion, degree of stenosis, and epicardial fat) had a higher discriminatory power than biomarkers in predicting adverse events, suggesting that knowing the coronary anatomy of patients with UA may be a powerful prognostic marker.…”

“…Literature regarding the risk stratification of NSTEACS is limited. Several studies have included patients with NSTEMI and UA [6][7][8], using biomarkers other than hsTn [6][7][8][9][10] (e.g., NTproBNP), echocardiogram [9], or coronary computed tomographic angiography findings [10] to assess prognosis. However, data specifically evaluating the occurrence of significant coronary artery disease (CAD) and the need for myocardial revascularization in UA patients are scarce.…”