Baseline NT-proBNP as a prognostic marker in acute coronary syndrome patients undergoing percutaneous coronary intervention: a systematic review and meta-analysis

Background N-terminal pro-B-type natriuretic peptide (NT-proBNP) reflects myocardial wall stress and neurohormonal activation. We evaluated whether elevated baseline preprocedural NT-proBNP is independently associated with all-cause mortality and composite adverse cardiovascular events in adults with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). Methods This systematic review and meta-analysis was conducted in accordance with PRISMA. Five databases were searched from inception through December 31, 2025. Eligible studies enrolled adults with ACS undergoing PCI, measured NT-proBNP preprocedurally, and reported adjusted effect estimates for clinical outcomes. Hazard ratios (HRs) and odds ratios (ORs) were pooled separately using random-effects inverse-variance models with restricted maximum likelihood estimation and Hartung–Knapp confidence interval adjustment. Results Thirteen studies (n=13,361 participants) met eligibility criteria for qualitative synthesis; nine contributed to at least one quantitative meta-analysis. For all-cause mortality, elevated baseline NT-proBNP was associated with increased risk in both HR-based analyses (pooled HR 2.17, 95% CI 1.48–3.19; I2=0.0%) and OR-based analyses (pooled OR 3.58, 95% CI 1.52–8.43; I2=0.0%). For composite cardiovascular events, the primary HR-based analysis of 3 studies with fully adjusted estimates demonstrated a significant and homogeneous association (pooled HR 1.84, 95% CI 1.32–2.56; I2=0.0%). A sensitivity analysis incorporating a fourth study (Wang K 2021) with a univariable NT-proBNP estimate yielded a pooled HR of 2.38 (95% CI 1.10–5.13; I2=83.6%); leave-one-out analysis identified the Wang et al. study as the sole driver of heterogeneity Conclusions Elevated baseline NT-proBNP is independently and consistently associated with all-cause mortality after PCI in ACS populations and appears to be associated with broader adverse cardiovascular outcomes. These findings support baseline NT-proBNP as a clinically relevant preprocedural risk stratification marker in ACS, pending greater standardization of exposure definitions and outcome reporting.