Abstract
Background: N-terminal pro-brain natural peptide (NT-pro-BNP) is a well-established biomarker of tissue congestion and has prognostic value in patients with heart failure (HF). Nonetheless, there is scarce evidence on its predictive capacity for HF re-admission after an acute coronary syndrome (ACS). We performed a prospective, single-center study in all patients discharged after an ACS. HF re-admission was analyzed by competing risk regression, taking all-cause mortality as a competing event. Results are presented as sub-hazard ratios (sHR). Recurrent hospitalizations were tested by negative binomial regression, and results are presented as incidence risk ratio (IRR). Results: Of the 2133 included patients, 528 (24.8%) had HF during the ACS hospitalization, and their pro-BNP levels were higher (3220 pg/mL vs. 684.2 pg/mL; p < 0.001). In-hospital mortality was 2.9%, and pro-BNP was similarly higher in these patients. Increased pro-BNP levels were correlated to increased risk of HF or death during the hospitalization. Over follow-up (median 38 months) 243 (11.7%) patients had at least one hospital readmission for HF and 151 (7.1%) had more than one. Complete revascularization had a preventive effect on HF readmission, whereas several other variables were associated with higher risk. Pro-BNP was independently associated with HF admission (sHR: 1.47) and readmission (IRR: 1.45) at any age. Significant interactions were found for the predictive value of pro-BNP in women, diabetes, renal dysfunction, STEMI and patients without troponin elevation. Conclusions: In-hospital determination of pro-BNP is an independent predictor of HF readmission after an ACS.
Highlights
We included 2133 patients (Table 1) and 528 (24.8%) had heart failure (HF) within the acute coronary syndrome (ACS) hospitalization, and they had higher pro-BNP than the rest: 3220 pg/mL vs. 684.2 pg/mL (p < 0.001)
We found a strong relationship between pro-BNP and in-hospital HF or mortality, which might help identify patients with poorer outcomes in whom close or intense management should be mandatory
We found relevant interactions between pro-BNP and female gender, diabetes, renal dysfunction, STEMI or troponin elevation
Summary
Coronary heart disease is the leading risk factor for heart failure incidence [1,2,3], and acute coronary syndrome (ACS) is the most frequent and threatening clinical presentation. N-terminal pro-brain natural peptide (NT-pro-BNP) is a well-established biomarker of tissue congestion and has prognostic value in patients with heart failure (HF). Recurrent hospitalizations were tested by negative binomial regression, and results are presented as incidence risk ratio (IRR). Results: Of the 2133 included patients, 528 (24.8%) had HF during the ACS hospitalization, and their pro-BNP levels were higher (3220 pg/mL vs 684.2 pg/mL; p < 0.001). In-hospital mortality was 2.9%, and pro-BNP was higher in these patients.
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