Abstract 8166: Elevated N-Terminal Pro-Brain Natriuretic Peptide Increases the Risk of Recurrent Thromboembolic Events After Acute Pulmonary Embolism

Abstract

Introduction: N-Terminal Pro-Brain Natriuretic Peptide (NTproBNP) is a predictor of short-term clinical adverse outcome in patients with acute pulmonary embolism (APE), but its long-term prognostic value remains largely undefined. Hypothesis: We assessed the hypothesis that elevated plasma NTproBNP level is associated with recurrent venous thromboembolism (VTE). Methods: On admission, NTproBNP levels were measured in 224 consecutive patients with the first episode of acute pulmonary embolism occurring from January 2005 through October 2010. Patients were categorized to two groups by NTproBNP reference range and followed up at 3, 6, and 12 months and yearly thereafter. The primary end point was symptomatic, recurrent fatal or nonfatal VTE. Results: NTproBNP was elevated in 158 (71%) patients and not elevated in 66 (29%) patients. After a mean follow-up period of 31.0±19.4 months, patients with elevated NTproBNP showed an increased risk of recurrent VTE (20 patients, 12.7%) compared with those not elevated (only 1 patient, 1.5%) ( P =0.009). 6 of 7 deaths related to pulmonary embolism occurred in patients with NTproBNP elevated, compared with patients with NTproBNP normal (1 of 7 deaths, P=0.64). At multivariate analysis stratified by oral anticoagulant treatment duration, elevated NTproBNP was an independent predictor of recurrent VTE (hazard ratio; 10.50; P =0.02). Conclusions: Elevated NTproBNP is associated with the increased risk of VTE recurrence in acute pulmonary embolism patients.