Additive prognostic value of NT-proBNP over TIMI risk score in intermediate-risk patients with acute coronary syndrome [Turk Kardiyol Dern Ars]
Turk Kardiyol Dern Ars. 2009; 37(1): 1-8

Additive prognostic value of NT-proBNP over TIMI risk score in intermediate-risk patients with acute coronary syndrome

Nihan Kahya Eren1, Faruk Ertaş1, Ümit Yüksek1, Çayan Çakır1, Cem Nazlı1, Mehmet Köseoğlu2, Oktay Ergene1
1Department of Cardiology, Izmir Ataturk Training and Research Hospital, Izmir
2Departments of Biochemistry, İzmir Atatürk Training and Research Hospital, İzmir


OBJECTIVES
We evaluated the prognostic value of N-terminal pro-brain natriuretic peptide (NT-proBNP) for further risk stratification of intermediate-risk patients with non-ST elevation acute coronary syndromes (NSTE-ACS).

STUDY DESIGN
The study included 137 intermediate-risk patients (85 men, 52 women; mean age 62±11 years) with ACS, based on the TIMI risk score (scores 3 to 5). Serum NT-proBNP levels were measured 12 hours after the last anginal episode. The patients were divided into four groups according to the following NT-proBNP quartiles: 17-310 pg/ml (n=34), 313-688 pg/ml (n=35), 724-2,407 pg/ml (n=34), and 2,575-24,737 pg/ml (n=34). Primary endpoint of the study was mortality. The mean follow-up was 21.8±7.1 months.

RESULTS
There were 27 deaths (19.7%), 14 of which were in the 4th quartile (4th vs 1st, 2nd, and 3rd quartiles: p=0.02, p=0.01, and p<0.01, respectively). The first three quartiles did not differ significantly in this respect. In Kaplan-Meier analysis, patients in the 4th quartile had the lowest cumulative survival (log rank test, 4th vs 1st, 2nd, and 3rd quartiles: p=0.041, p=0.026, and p=0.009, respectively). NT-proBNP level was significantly higher in nonsurvivors than in survivors (p=0.01). In univariate analysis, mortality was also associated with the TIMI risk score, ejection fraction, and age. Patients who died were older (65.6±11.9 years vs 60.7±11.0 years; p=0.048) and had a lower ejection fraction (46.3±11% vs 54.1±9.8%; p<0.001) than patients who survived. Mortality rates corresponding to TIMI risk scores of 3, 4, and 5 were 25.9%, 29.6%, and 44.4%, respectively (p=0.58 for TIMI 3 vs 4; p=0.001 for TIMI 3 vs 5; p=0.013 for TIMI 4 vs 5). Cox proportional hazards regression analysis showed that only TIMI risk score was an independent predictor of mortality (hazard ratio 2.3, 95% confidence interval 1.4-3.8, p=0.001).

CONCLUSION
NT-proBNP has an additive predictive value over TIMI risk score in predicting long-term mortality in intermediate-risk patients with ACS.

Keywords: Angina, unstable, biological markers; coronary disease; natriuretic peptide, brain; prognosis; risk assessment.

How to cite this article
Nihan Kahya Eren, Faruk Ertaş, Ümit Yüksek, Çayan Çakır, Cem Nazlı, Mehmet Köseoğlu, Oktay Ergene. Additive prognostic value of NT-proBNP over TIMI risk score in intermediate-risk patients with acute coronary syndrome. Turk Kardiyol Dern Ars. 2009; 37(1): 1-8

Corresponding Author: Nihan Kahya Eren, Türkiye
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