Prognostic significance of serial NT-proBNP levels in patients with acute myocardial infarction: A prospective study

Methods and results

Between March 2017 and January 2020, 1105 patients with AMI who underwent emergency PCI were included. NT-proBNP levels were measured on days 0, 1, 2, 3, and 7. A composite of all-cause death, MI recurrence (reMI), and rehospitalization due to heart failure, known as major adverse cardiovascular events (MACE), was recorded. During the 36.8-month follow-up, 175 patients (15.8%) experienced MACEs. When patients were grouped based on quartiles of NT-proBNP levels on days 0 and 7, the results demonstrated that patients in quartile 4 showed a substantially increased MACE risk compared to those in quartile 1 [hazard ratio (HR) 2.27, 95% confidence interval (CI):1.27-4.08, P = 0.006; HR 2.20, 95%CI:1.23-3.94, P = 0.008]. There were U-shaped relationships between the HR for MACE and NT-proBNP levels on days 2, 3, and 7, as well as peak NT-proBNP (P for nonlinearity = 0.007, 0.006, 0.004, and 0.009, respectively). A similar relationship was observed in the HR for reMI and NT-proBNP levels on days 2 and 3. For MACE at 3 years, serial NT-proBNP levels improved the predictive accuracy of the Global Registry of Acute Coronary Events risk (GRACE) score [concordance index (C-index): 0.711; continuous net reclassification improvement (NRI): 0.192, 95% CI: 0.022-0.445; integrated discrimination improvement (IDI): 0.034, 95% CI: 0.016-0.064]. For all-cause death at 3 years, the combination of NT-proBNP and GRACE score showed excellent performance, with C-index, continuous NRI, and IDI values of 0.801, 0.373 (95%CI: 0.072-0.853), and 0.051 (95%CI: 0.025-0.091), respectively.

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