Does admission NT-proBNP increase the prognostic accuracy of GRACE risk score in the prediction of short-term mortality after acute coronary syndromes?
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).


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.
Timóteo
Ana Teresa
AT
Cardiology Department, Santa Marta Hospital, Lisbon, Portugal. ana_timoteo@yahoo.com
Toste
Alexandra
A
Ramos
Ruben
R
Miranda
Fernando
F
Ferreira
Maria Lurdes
ML
Oliveira
José Alberto
JA
Ferreira
Rui Cruz
RC
D054058:Acute Coronary Syndrome / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000401:mortality; D000704:Analysis of Variance; D015415:Biomarkers / Q000097:blood*; D016009:Chi-Square Distribution; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010343:Patient Admission; D010446:Peptide Fragments / Q000097:blood*; D011174:Portugal / Q000453:epidemiology; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D018487:Ventricular Dysfunction, Left / Q000209:etiology
D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain