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- 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.
- Authors
Schellings, Dirk A. A. M.; Adiyaman, Ahmet; Dambrink, Jan-Henk E.; Gosselink, A. T. Marcel; Kedhi, Elvin; Roolvink, Vincent; Ottervanger, Jan Paul; van't Hof, Arnoud W. J.; Schellings, Dirk Aam; Gosselink, At Marcel; Van't Hof, Arnoud Wj
- Abstract
<bold>Background: </bold>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. <bold>Purpose: </bold>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. <bold>Methods: </bold>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. <bold>Results: </bold>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 0.87 p=0.67) but was considerably higher in comparison to the TIMI risk score (AUC 0.60 p<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). <bold>Conclusion: </bold>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.
- Subjects
ACUTE coronary syndrome; BRAIN natriuretic factor; BIOMARKERS; CARDIOVASCULAR disease related mortality; MYOCARDIAL infarction risk factors; THROMBOLYTIC therapy; PROGNOSIS
- Publication
Vascular Health & Risk Management, 2016, Vol 12, p471
- ISSN
1176-6344
- Publication type
journal article
- DOI
10.2147/VHRM.S117204