Does Admission NT-ProBNP Increase the Prognostic Accuracy of GRACE Risk Score in the Prediction of Short-Term Mortality After Acute Coronary Syndromes?

• Autor(a) principal: Timóteo, AT
• Data de Publicação: 2009
• Outros Autores: Toste, A, Ramos, R, Miranda, F, Ferreira, ML, Oliveira, JA, Cruz Ferreira, R
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: http://hdl.handle.net/10400.17/2672
• topic: Analysis of Variance; Biomarkers/blood; Chi-Square Distribution; Female; Humans; Linear Models; Logistic Models; Male; Middle Aged; Multivariate Analysis; Natriuretic Peptide, Brain/blood; Peptide Fragments/blood; Portugal/epidemiology; Predictive Value of Tests; Prognosis; ROC Curve; Retrospective Studies; Risk Assessment/methods; Risk Factors; Severity of Illness Index; Statistics, Nonparametric; Ventricular Dysfunction, Left/etiology; Acute Coronary Syndrome/blood; Hospital Mortality; Patient Admission; HSM CAR; HSM PAT CLIN; Acute Coronary Syndrome/complications; Acute Coronary Syndrome/diagnosis; Acute Coronary Syndrome/mortality

BACKGROUND: NT-proBNP has prognostic implications in heart failure. In acute coronary syndromes (ACS) setting, the prognostic significance of NT-proBNP is being sought. We studied short-term prognostic impact of admission NT-proBNP in patients admitted for ACS and in association with GRACE risk score (GRS). METHODS AND RESULTS: We studied 1035 patients admitted with ACS. Patients were divided in quartiles according to NT-proBNP levels on admission: Q1 <180 pg/ml; Q2 180-691 pg/ml; Q3 696-2664 pg/ml; Q4 2698-35 000 pg/ml. Groups were compared in terms of short-term all-cause mortality. Patients with higher NT-proBNP had worst GRS on admission. They also received less aggressive treatment. In-hospital mortality was 0.8%, 3.0%, 5.8% and 12.8% (P<0.001) and 30-day mortality 1.6%, 4.6%, 6.5% and 16.7% (P<0.001) respectively. In multivariate logistic regression analysis, NT-proBNP is an independent predictor of in-hospital (OR 2.35; 95% CI: 1.12-4.93, P=0.022) and 30-day mortality (OR 2.20; 95% CI: 1.17-4.12, P=0.014). However, NT-proBNP does not add any incremental benefit to GRS for prediction of outcome by ROC curve analysis. CONCLUSIONS: NT-proBNP is an independent predictor of in-hospital and 30-day mortality after ACS, independently of left ventricular function, but does not increase the prognostic accuracy of GRS.