Abstract
BackgroundIt remained unclear whether the combination of the Canada Acute Coronary Syndrome Risk Score (CACS-RS) and N-terminal pro-brain natriuretic peptide (NT-pro-BNP) could have a better performance in predicting clinical outcomes in acute ST-elevation myocardial infarction (STEMI) patients with primary percutaneous coronary intervention.MethodsA total of 589 consecutive STEMI patients were enrolled. The potential additional predictive value of NT-pro-BNP with the CACS-RS was estimated. Primary endpoint was in-hospital mortality and long-term poor outcomes.ResultsThe incidence of in-hospital death was 3.1%. Patients with higher NT-pro-BNP and CACS-RS had a greater incidence of in hospital death. After adjustment for the CACS-RS, elevated NT-pro-BNP (defined as the best cutoff point based on the Youden’s index) was significantly associated with in hospital death (odd ratio = 4.55, 95%CI = 1.52–13.65, p = 0.007). Elevated NT-pro-BNP added to CACS-RS significantly improved the C-statistics for in-hospital death, as compared with the original score (0.762 vs. 0.683, p = 0.032). Furthermore, the addition of NT-pro-BNP to CACS-RS enhanced net reclassification improvement (0.901, p < 0.001) and integrated discrimination improvement (0.021, p = 0.033), suggesting effective discrimination and reclassification. In addition, the similar result was also demonstrated for in-hospital major adverse clinical events (C-statistics: 0.736 vs. 0.695, p = 0.017) or 3-year mortality (0.699 vs. 0.604, p = 0.004).ConclusionsBoth NT-pro-BNP and CACS-RS are risk predictors for in hospital poor outcomes in patients with STEMI. A combination of them could derive a more accurate prediction for clinical outcome s in these patients.
Highlights
It remained unclear whether the combination of the Canada Acute Coronary Syndrome Risk Score (CACS-RS) and N-terminal pro-brain natriuretic peptide (NT-pro-BNP) could have a better performance in predicting clinical outcomes in acute ST-elevation myocardial infarction (STEMI) patients with primary percutaneous coronary intervention
From the CACS-RS low risk to high risk, there was a positive trend with older age, NT-pro-BNP levels, and the pre-procedural SCr level
There was a negative trend with the pre-procedural renal function and left ventricular ejection fraction (LVEF)
Summary
It remained unclear whether the combination of the Canada Acute Coronary Syndrome Risk Score (CACS-RS) and N-terminal pro-brain natriuretic peptide (NT-pro-BNP) could have a better performance in predicting clinical outcomes in acute ST-elevation myocardial infarction (STEMI) patients with primary percutaneous coronary intervention. Despite significant advances in treatment and prevention, patients with ST-elevation myocardial infarction (STEMI) still remained important population with high risk of adverse clinical outcomes [1], especially in. He et al BMC Cardiovascular Disorders (2016) 16:255 than others [5]. The Canada Acute Coronary Syndrome Risk Score (CACS-RS), has been shown to permit rapid stratification of patients with acute coronary syndrome (ACS) [6]. There has been no simple and effective risk model incorporating NT-pro-BNP for predicting the prognosis of STEMI patients
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