Key result
Elevated baseline NT-proBNP linked to ~3.5-fold higher 1-month major cardiovascular events risk after emergency PCI for STEMI.
Why the study?
The prognostic significance of NT-proBNP in STEMI patients after PCI has not been fully elucidated.
Does elevated baseline NT-proBNP predict short-term major adverse cardiovascular events in patients with STEMI undergoing emergency PCI?
Cohort (n=405)
No
Does elevated baseline NT-proBNP predict short-term major adverse cardiovascular events in patients with STEMI undergoing emergency PCI?
Baseline NT-proBNP exceeding 3,236 pg/mL immediately following primary PCI is a strong independent predictor of short-term adverse cardiovascular events in STEMI patients.
Answers are grounded in this paper and cite their sources.
NT-proBNP >3,236 pg/mL associated with higher 1-month MACE after STEMI PCI; leaves open incremental value for risk stratification.
Background. The prognostic significance of the amino-terminal fragment of the prohormone brain-type natriuretic peptide (NT-proBNP) in patients with ST-segment elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI) has not been fully elucidated. Major adverse cardiovascular events (MACEs) are clinically viable indicators for the accurate, rapid, and safe evaluation of patients with STEMI. This study was designed to investigate the relationship between NT-proBNP levels and the occurrence of short-term MACEs in patients with STEMI who underwent emergency PCI. Methods. This prospective cohort study included 405 patients with STEMI aged 20–90 years who underwent emergency PCI at the First People’s Hospital of Changde City from April 6, 2017, to May 31, 2019. Stent thrombosis, reinfarction, congestive heart failure, unstable angina, and cardiac death were considered as MACEs in this study. The target-independent and -dependent variables were NT-proBNP at baseline and MACE, respectively. Results. There were 28.25% of MACEs. Age, number of implanted stents, Killip class, infarction-related artery, applied intra-aortic balloon pump (IABP), creatine kinase (CK) peak value, CK-MB peak value, TnI peak value, and ST-segment resolution were independently associated with MACE ( <a:math xmlns:a="http://www.w3.org/1998/Math/MathML" id="M1"> <a:mi>P</a:mi> <a:mo><</a:mo> <a:mn>0.05</a:mn> </a:math> ). In a multivariate model, after adjusting all potential covariates, Log2 NT-proBNP levels remained significantly associated with MACE, with an inflection point of 11.66. The effect sizes and confidence intervals of the left and right sides of the inflection point were 1.07 and 0.84–1.36 ( <c:math xmlns:c="http://www.w3.org/1998/Math/MathML" id="M2"> <c:mi>P</c:mi> <c:mo>=</c:mo> <c:mn>0.5730</c:mn> </c:math> ) and 3.47 and 2.06–5.85 ( <e:math xmlns:e="http://www.w3.org/1998/Math/MathML" id="M3"> <e:mi>P</e:mi> <e:mo><</e:mo> <e:mn>0.0001</e:mn> </e:math> ), respectively. Conclusions. In patients with STEMI who underwent PCI, Log2 NT-proBNP was positively correlated with MACE within 1 month when the Log2 NT-proBNP was >11.66 (NT-proBNP >3.236 pg/mL).
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Qin et al. (2021) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) (n=405). Elevated baseline NT-proBNP (>3,236 pg/mL) vs. Baseline NT-proBNP ≤3,236 pg/mL was evaluated on Major adverse cardiovascular events (MACE) within 1 month (composite of all-cause death, stent thrombosis, reinfarction, congestive heart failure, and angina pectoris) (OR 3.47, 95% CI 2.06-5.85, p=<0.0001). In patients with STEMI undergoing emergency PCI, baseline NT-proBNP > 3,236 pg/mL was strongly associated with an increased risk of 1-month major cardiovascular events.
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