title: Predictive value of NT-proBNP for 30-day mortality in patients with non-ST-elevation acute coronary syndromes: a comparison with the GRACE and TIMI risk scores.
abstract: BACKGROUND
  The biomarker N-terminal pro-brain natriuretic peptide (NT-proBNP) predicts outcome in patients with non-ST-elevation acute coronary syndromes (NSTE-ACS). Whether NT-proBNP has incremental prognostic value beyond established risk strategies is still questionable.
  
  
  OBJECTIVE
  To evaluate the predictive value of NT-proBNP for 30-day mortality over and beyond the Global Registry of Acute Coronary Events (GRACE) and Thrombolysis In Myocardial Infarction (TIMI) risk scores in patients with NSTE-ACS.
  
  
  METHODS
  Patients included in our ACS registry were candidates. NT-proBNP levels on admission were measured and the GRACE and TIMI risk scores were assessed. We compared the predictive value of NT-proBNP to both risk scores and evaluated whether NT-proBNP improves prognostication by using receiver operator curves and measures of discrimination improvement.
  
  
  RESULTS
  A total of 1324 patients were included and 50 patients died during follow-up. On logistic regression analysis NT-proBNP and the GRACE risk score (but not the TIMI risk score) both independently predicted mortality at 30 days. The predictive value of NT-proBNP did not differ significantly compared to the GRACE risk score (area under the curve [AUC]) 0.85 vs 0.87p=0.67) but was considerably higher in comparison to the TIMI risk score (AUC 0.60p<0.001). Adjustment of the GRACE risk score by adding NT-proBNP did not improve prognostication: AUC 0.86 (p=0.57), integrated discrimination improvement 0.04 (p=0.003), net reclassification improvement 0.12 (p=0.21).
  
  
  CONCLUSIONS
  In patients with NSTE-ACS, NT-proBNP and the GRACE risk score (but not the TIMI risk score) both have good and comparable predictive value for 30-day mortality. However, incremental prognostic value of NT-proBNP beyond the GRACE risk score could not be demonstrated.
authors.affiliation: Department of Cardiology, Isala Heart Centre, Zwolle; Department of Cardiology, Slingeland Hospital, Doetinchem, the Netherlands.
authors.forename: Dirk Aam
authors.initials: DA
authors.lastname: Schellings
authors.affiliation: Department of Cardiology, Isala Heart Centre, Zwolle.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Adiyaman
authors.affiliation: Department of Cardiology, Isala Heart Centre, Zwolle.
authors.forename: Jan-Henk E
authors.initials: JE
authors.lastname: Dambrink
authors.affiliation: Department of Cardiology, Isala Heart Centre, Zwolle.
authors.forename: At Marcel
authors.initials: AM
authors.lastname: Gosselink
authors.affiliation: Department of Cardiology, Isala Heart Centre, Zwolle.
authors.forename: Elvin
authors.initials: E
authors.lastname: Kedhi
authors.affiliation: Department of Cardiology, Isala Heart Centre, Zwolle.
authors.forename: Vincent
authors.initials: V
authors.lastname: Roolvink
authors.affiliation: Department of Cardiology, Isala Heart Centre, Zwolle.
authors.forename: Jan Paul
authors.initials: JP
authors.lastname: Ottervanger
authors.affiliation: Department of Cardiology, Isala Heart Centre, Zwolle.
authors.forename: Arnoud Wj
authors.initials: AW
authors.lastname: Van't Hof
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood* / Q000175:diagnosis / Q000401:mortality*; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D017023:Coronary Angiography; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D000072658:Non-ST Elevated Myocardial Infarction / Q000097:blood* / Q000175:diagnosis / Q000401:mortality*; D016017:Odds Ratio; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: GRACE risk score; NSTE-ACS; NT-proBNP; TIMI risk score; myocardial infarction