Key result
In patients with acute myocardial infarction, a 1-SD increase in ln-transformed NT-proBNP was independently associated with an 82% increased risk of all-cause mortality (HR 1.82).
Why the study?
The prognostic value of NT-proBNP across BMI categories in patients with acute myocardial infarction remains unclear.
Does NT-proBNP level predict mortality in patients with acute myocardial infarction across different BMI categories?
Cohort (n=4,677)
No
Does NT-proBNP level predict mortality in patients with acute myocardial infarction across different BMI categories?
NT-proBNP is an independent predictor of mortality in AMI, but optimal prognostic cutoff values are inversely related to BMI and should be adjusted accordingly.
BACKGROUND: The prognostic value of N-terminal pro-B-type natriuretic peptide (NT-proBNP) across body mass index (BMI) categories in patients with acute myocardial infarction (AMI) is unclear. We aimed to assess the predictive value of NT-proBNP levels and identify the best cutoff values for mortality risk prediction across BMI categories in AMI. METHODS: ) groups. The association between NT-proBNP (ln-transformed) and mortality was investigated using Cox regression and stratified by BMI. RESULTS: During follow-up (13,787 person-years of observation), 718 patients died, averaging 52.1 events per 1000 person-years. NT-proBNP levels were inversely correlated with BMI (β = - 0.096, P < 0.001). After adjustment, NT-proBNP was independently associated with all-cause mortality (hazard ratio [HR] per 1-SD: 1.82; 95% confidence interval [CI] 1.60-2.07) in patients with AMI. Similar findings were observed in analyses stratified by BMI category, except for the underweight group. Adding NT-proBNP to conventional risk models improved risk discrimination in normal-weight, overweight, and obese patients (C-index changes of 0.036, 0.042, and 0.032, respectively) and classification of patients into predicted mortality risk categories (net reclassification improvement 0.263, 0.204, and 0.197, respectively). The best NT-proBNP cutoff values for 5-year mortality risk prediction across BMI categories were 5710, 4492, 2253, and 1300 pg/ml. CONCLUSION: NT-proBNP level was an independent prognostic factor for mortality in patients with AMI and varied according to BMI. The best NT-proBNP cutoff values for mortality risk prediction reduced as BMI increased.
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Wang et al. (2023) conducted a cohort in Acute myocardial infarction (n=4,677). N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels vs. Per 1-SD increase was evaluated on All-cause mortality (HR 1.82, 95% CI 1.60-2.07, p=<0.001). In patients with acute myocardial infarction, a 1-SD increase in ln-transformed NT-proBNP was independently associated with an 82% increased risk of all-cause mortality (HR 1.82).
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