Prognostic value of brain natriuretic peptide in ST-elevation myocardial infarction

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background Prognostic value of brain natriuretic peptide (BNP) in STEMI is not yet fully stablished despite many studies demonstrating its potential in providing additional information. Purpose Evaluation of prognostic impact of BNP in coronary anatomy complexity and outcomes in the context of STEMI. Methods Retrospective analysis of patients admitted with STEMI in a multicentric registry between 2010-19. Patients were divided into 3 groups regarding BNP: <100pg/ml in Group 1 (39%P); 100≤ BNP <400pg/ml in Group 2 (39.5%); and BNP ≥400pg/ml in Group 3 (21.5%). Demographic and clinical characteristics were compared and outcomes evaluated. A Cox multivariate regression was performed to evaluate predictor factors of stablished endpoints. Survival was evaluated through Kaplan-Meier curve. Results 1650 patients were reviewed. Group 1 was younger (58±11 vs 66±13 vs 72±12 years, p<0.001). Mostly male (75.4%, p<0.001). Patients with heart failure (HF) and chronic kidney disease (CKD) presented higher BNP: the prevalence of HF and CKD was 0.5 and 1.3% in Group 1; 1.8 and 2.5% in Group 2; 5.9 and 7.8% in Group 3 (p<0.001). Mean BNP at admission was 43±26 in Group 1; 208±81 in Group 2; 1105±1073pg/ml in Group 3 (p<0.001). Group 3 presented lower mean left ventricle ejection fraction (LVEF): 58±11 vs 53±12 vs 44±13% (p<0.001). All patients were submitted to coronary angiography: the anterior descendent was the artery most frequently involved (57.4 vs 66.9 vs 80.3%, p<0.001). The involvement of >1 coronary artery was more frequent in Group 3 (34.4 vs 44.5 vs 51.3%, p<0.001). Acute HF (6.5 vs 16.7 vs 45.4%, p<0.001); cardiogenic shock (3.3 vs 5.1 vs 16.9%, p<0.001), atrial fibrillation (3.0 vs 6.4 vs 16.9%, p<0.001), stroke (0.5 vs 0.6 vs 2%, p 0.032), sustained ventricular tachycardia (1.6 vs 3.7 vs 6.8, p<0.001) and mortality (1.2 vs 2.6 vs 8.5%, p 0.017) were more prevalent in Group 3. Kaplan-Meier curve confirmed that higher BNP was associated with higher rates of 1-year mortality (p<0.001) and cardiovascular and all-cause rehospitalization (p 0.005 and 0.002). Presence of peripheral arterial disease or cancer, Killip Kimball class >I, LVEF <50% and occurrence of mechanical complications were predictor factors. Conclusions In context of STEMI, higher BNP levels were associated with more complex coronary anatomy and higher in-hospital and 1-year morbimortality.