title: Usefulness of N-terminal pro-B-type natriuretic Peptide levels for stroke risk prediction in anticoagulated patients with atrial fibrillation.
abstract: OBJECTIVE
  Oral anticoagulation is highly effective in reducing stroke and mortality in atrial fibrillation (AF). Several risk stratification schemes have been developed using clinical characteristics. Elevated levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP) are important markers of increased mortality and morbidity in congestive heart failure and general community population. The aim of our study was to assess the predictive value of NT-proBNP levels in an unselected real-world cohort of anticoagulated patients with AF.
  
  
  METHODS
  We studied 1172 patients (49% male; median age, 76 years) with permanent AF who were well stabilized on oral anticoagulation (international normalized ratio, 2.0-3.0). Plasma NT-proBNP levels were quantified at baseline. We recorded thrombotic and vascular events, mortality, and major bleeding. The best cutoff points were assessed by receiver-operating characteristic curves.
  
  
  RESULTS
  Median levels (interquartile range) of NT-proBNP were 610 (318-1037) pg/mL. Median follow-up was 1007 (806-1279) days. On multivariate analysis, high NT-proBNP was significantly associated with the risk of stroke (hazards ratio, 2.71; P=0.001) and composite vascular events (acute coronary syndrome or acute heart failure; hazards ratio, 1.85; P=0.016), as well as a significant association with mortality (adjusted hazards ratio, 1.66; P=0.006). No association with bleeding was found (P=0.637). The integrated discrimination improvement (IDI) analysis demonstrated that NT-proBNP improved the Congestive heart failure, Hypertension, Age≥75 (doubled), Diabetes mellitus, Stroke (doubled)-Vascular disease and Sex category (female); CHA2DS2-VASc score for predicting embolic events (relative IDI, 2.8%; P=0.001) and all-cause death (relative IDI, 1.8%; P=0.001).
  
  
  CONCLUSIONS
  In real-world cohort of anticoagulated patients with AF, NT-proBNP provided complementary prognostic information to an established clinical risk score (CHA2DS2-VASc) for the prediction of stroke/systemic embolism. NT-proBNP was also predictive of all-cause mortality, suggesting that this biomarker may potentially be used to refine clinical risk stratification in anticoagulated patients with AF.
authors: From the Hematology and Medical Oncology Unit, Hospital Universitario Morales Meseguer, University of Murcia, Spain (V.R., J.G., V.V.); Departments of Cardiology (J.A.V., S.M.-F., E.J., C.M.P., M.V., F.M.) and Clinical Analysis (J.A.V., C.M.P.), Hospital Universitario Virgen de la Arrixaca, University of Murcia, Spain; and the University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK (G.Y.H.L.).
authors: Vanessa
authors: V
authors: Roldán
authors: Juan Antonio
authors: JA
authors: Vílchez
authors: Sergio
authors: S
authors: Manzano-Fernández
authors: Eva
authors: E
authors: Jover
authors: Josefa
authors: J
authors: Gálvez
authors: Carmen M
authors: CM
authors: Puche
authors: Mariano
authors: M
authors: Valdés
authors: Vicente
authors: V
authors: Vicente
authors: Gregory Y H
authors: GY
authors: Lip
authors: Francisco
authors: F
authors: Marín
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications*; D015415:Biomarkers / Q000097:blood*; D002318:Cardiovascular Diseases / Q000401:mortality; D015331:Cohort Studies; D023381:Endpoint Determination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D012044:Regression Analysis; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000097:blood* / Q000188:drug therapy / Q000401:mortality
chemical_list: D000925:Anticoagulants; D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: B-type natriuretic peptide; anticoagulants; atrial fibrillation; stroke