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.
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. (2026) studied this question. 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%.