Concordance between E/e′ratio and NT-proBNP levels for predicting late-onset heart failure events in patients with acute coronary syndrome(CONCORD-ACS Study)

Background Heart failure (HF) is a frequent complication following acute coronary syndrome (ACS) and is associated with increased morbidity and mortality. The E/e′ ratio by echocardiography and serum NT-proBNP levels are widely used for diagnosing HF in clinical practice, however combined these parameters as a predictor for subsequent heart failure events in patients with ACS remains limited. Objective To determine the prognostic value of the E/e′ ratio and NT-proBNP levels for heart failure events following hospital discharge after acute coronary syndrome. Methods This retrospective cohort study included patients who were diagnosed as ACS at our Hospital between July 1st, 2021, and August 31st, 2025. Data were obtained from electronic medical records. The primary endpoint was late-onset heart failure events defined as outpatient department or emergency room visits requiring diuretic therapy, hospitalization due to HF within 90 days after discharge. Patients were classified to concordance or discordance of E/e′ ratio and NT-proBNP levels. Hazard ratios (HRs) were calculated using univariate and multivariate Cox proportional hazards regression models, and survival outcomes were analyzed using Kaplan–Meier curves. Results A total of 195 patients with ACS were included in the study. During the 90-day follow-up period, patients with concordantly elevated E/e′ ratio and NT-proBNP levels demonstrated a significantly higher incidence of late-onset heart failure events compared with those with concordantly low values (HR 4.50; 95% CI, 1.05–24.12; P = 0.042). Patients with discordant findings showed a non-significant increase in risk (HR 2.36; 95% CI, 0.51–10.93; P = 0.271). The incidence rates of late–onset heart failure events were 3.21 per 1,000 person-days (95% CI, 2.11–4.87) in the concordantly high group, 1.64 per 1,000 person-days in the discordant group, and 0.68 per 1,000 person-days in the concordantly low group. Conclusions The concordance of elevated E/e′ ratio and NT-proBNP levels is a strong predictor of heart failure events after discharge in patients with acute coronary syndrome. Combined assessment of these parameters may enhance early risk stratification and guide post-ACS management.