NT-proBNP was associated with a 2.34 hazard ratio for mortality per SD increment, independent of LVEF, while CRP was significant only for LVEF <50%.
Does routine NT-proBNP and CRP testing improve risk stratification for all-cause mortality in patients with reperfused acute STEMI?
Routine NT-proBNP testing improves mid-term mortality risk stratification in stabilized acute STEMI survivors regardless of LVEF, whereas CRP is predictive only in those with reduced LVEF.
Absolute Event Rate: 0% vs 0%
Background Biomarkers could improve risk stratification in patients with acute ST-segment elevation myocardial infarction (STEMI), beyond left ventricular ejection fraction (LVEF). Our study evaluated the association between N-terminal pro-B-type natriuretic peptide (NT-proBNP), C reactive protein (CRP) and mortality in a cohort of patients with acute STEMI. Methods This prospective, observational cohort study included patients with reperfused acute STEMI admitted to a tertiary cardiovascular disease centre between July 2020 and October 2023. All patients underwent NT-proBNP and CRP testing. The association between NT-proBNP, CRP and all-cause mortality was evaluated in relation to predischarge LVEF. Results The cohort included 566 patients with a mean age of 63 years. After a median follow-up of 39 months, postdischarge all-cause mortality reached 13.4%. NT-proBNP was associated with mortality irrespective of LVEF (HR 2.34 per SD increment in log NT-proBNP; p<0.001 at LVEF <50% and HR 2.36; p=0.004 at LVEF ≥50%), but the association between CRP and mortality was significant only in patients with LVEF <50% (HR 1.55, p=0.003). Across the cohort, NT-proBNP remained associated with death after adjustment for age, sex, diabetes, baseline high-sensitivity cardiac troponin T (hs-cTnT), CRP, final Thrombolysis in myocardial infarction (TIMI) flow grade and reduced LVEF (HR 1.45, p=0.03). In patients with preserved LVEF, routine NT-proBNP testing (area under the curve (AUC) 0.753 (0.642–0.863), p<0.001) improved risk stratification compared with isolated LVEF assessment (AUC 0.592 (0.453–0.730), p=0.18). Conclusions In a cohort of stabilised acute STEMI survivors, NT-proBNP was associated with all-cause mid-term mortality independent of hs-cTnT and LVEF. The association between CRP and mortality was significant only in patients with LVEF <50%.
Dregoesc et al. (Thu,) reported a other. NT-proBNP was associated with a 2.34 hazard ratio for mortality per SD increment, independent of LVEF, while CRP was significant only for LVEF <50%.