Increased levels of natriuretic peptides in stable patients three months after STEMI as a simple tool to predict long-term prognosis

Czech version

Authors: E. Ganovská ^1,2; J. Jarkovský ³; P. Kala ^1,2; M. Poloczek ¹; O. Toman ¹; M. Pávková Goldbergová ⁴; K. Kluz ⁵; L. Kubková ¹; M. Tesák ^1,5; L. Elbl ¹; Z. Čermáková ^6,7; M. Dastych ^6–8; P. Jeřábek ¹; O. Boček ¹; S. Littnerová ³; K. Benešová ³; J. Špinar ^1,2; J. Pařenica ^1,2
Authors‘ workplace: Interní kardiologická klinika FN Brno ¹; Lékařská fakulta MU, Brno ²; Institut biostatistiky a analýz LF MU, Brno ³; Ústav patologické fyziologie, LF MU Brno ⁴; Nemocnice Podlesí, Třinec ⁵; Oddělení klinické biochemie a hematologie, FN Brno ⁶; Katedra laboratorních metod, LF MU Brno ⁷; Interní oddělení, Nemocnice Třebíč ⁸
Published in: Kardiol Rev Int Med 2018, 20(1): 71-76

Overview

Background:
The development of heart failure after myocardial infarction is the cause of repeated hospitalizations for acute decompensation and a factor that significantly reduces quality of life. The prognostic value of natriuretic peptides in stable patients after STEMI treated with primary PCI has not been evaluated so far. The aim of this study was to determine the contribution of BNP or NT-proBNP for the prediction of the risk of hospitalization for acute heart failure, risk of mortality and their combination within 12 and 24 months.

Methods:
The study population consisted of 317 STEMI patients treated with primary PCI. The levels of BNP and NT-proBNP were measured at a follow-up control after 3 months.

Results:
The thresholds of BNP ≥ 189 pg/ mL or NT-proBNP ≥ 551 pg/ mL was a strong predictor of hospitalization over the following 12 months (AUC 0.916 and 0.854, both p < 0.001) and 24 months (AUC 0.878 and 0.855, both p < 0.001). Increased values of BNP and NT-proBNP were a significant predictor of 12- and 24-month mortality, respectively (AUC 0.720, resp. 0.793, all p ≤ 0.025) and a combined end-point at 12 resp. 24 months (ACU 0.791 resp. 0.824, all p < 0.001).

Conclusion:
The thresholds of BNP≥189 pg/ mL and NT-proBNP ≥ 551 pg/ ml measured at 3 months after STEMI in stable patients predict an increased risk of hospitalization due to acute heart failure decompensation, mortality and combined clinical endpoint in the first 2 years. Determination of natriuretic peptides is a simple tool to identify high-risk patients after myocardial infarction.

Key words:
natriuretic peptides – STEMI – heart failure – hospitalization – mortality – follow-up

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