Serial N-Terminal Pro Brain Natriuretic Peptide Assessments in Predicting New-Onset Atrial Fibrillation in ST Elevation Myocardial Infarction Patients who Undergo Primary Percutaneous Coronary Intervention

Abstract

Background: N-terminal pro-Brain Natriuretic Peptide(NT-proBNP)is associated with atrial fibrillation(AF) in the setting of acute ST-elevation myocardial infarction (STEMI), and the present study was aimed at assessing the temporal association between NT-proBNP and incident AF. Methods: 830 patients enrolled in On-TIME II were included. NT-proBNP was assessed at baseline, 24 h and 72 h after admission for STEMI. Patients with new-onset AF 72 h after admission. NT-proBNP serum levels at the three assessment intervals was used to predict the timing of AF with a receiver-operator characteristic, and a binary logistic model was created to predict the AF at the various timings. Results: Mean age was 62 ±12 years and 76% were male. 73 patients developed incident AF, 41 developed AF on admission, 14 patients developed AF 24-72 h after admission and 18 patients developed AF >72 h after admission. NT-proBNP at baseline (area under curve (AUC) 0.657, P<0.001), after 24 h (AUC 0.829, P<0.001) and after 72 h (AUC 0.891, P<0.001) predicted AF. However, NT-proBNP at baseline did not predict AF on admission (AUC 0.591, P=0.058). NT-proBNP after 24 h and 72 h were stronger predictors of AF compared to NT-proBNP at baseline. In regression analysis, NT-proBNP after 24 h (OR:1.220, P<0.001) and 72 h (OR:1.290, P<0.002) showed a significant association with postinfarction AF. Conclusion: This study shows serial NT-proBNP plasma level assessments enhance risk stratification for incident AF in STEMI patients.