Vascular Health and Risk Management (Nov 2016)

Predictive value of NT-proBNP for 30-day mortality in patients with non-ST-elevation acute coronary syndromes: a comparison with the GRACE and TIMI risk scores

  • Schellings DAAM,
  • Adiyaman A,
  • Dambrink JH,
  • Gosselink ATM,
  • Kedhi E,
  • Roolvink V,
  • Ottervanger JP,
  • van't Hof AWJ

Journal volume & issue
Vol. Volume 12
pp. 471 – 476

Abstract

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Dirk AAM Schellings,1,2 Ahmet Adiyaman,1 Jan-Henk E Dambrink,1 AT Marcel Gosselink,1 Elvin Kedhi,1 Vincent Roolvink,1 Jan Paul Ottervanger,1 Arnoud WJ van’t Hof,1 1Department of Cardiology, Isala Heart Centre, Zwolle, 2Department of Cardiology, Slingeland Hospital, Doetinchem, the Netherlands Background: The biomarker N-terminal pro-brain natriuretic peptide (NT-proBNP) predicts outcome in patients with non-ST-elevation acute coronary syndromes (NSTE-ACS). Whether NT-proBNP has incremental prognostic value beyond established risk strategies is still questionable.Purpose: To evaluate the predictive value of NT-proBNP for 30-day mortality over and beyond the Global Registry of Acute Coronary Events (GRACE) and Thrombolysis In Myocardial Infarction (TIMI) risk scores in patients with NSTE-ACS.Methods: Patients included in our ACS registry were candidates. NT-proBNP levels on admission were measured and the GRACE and TIMI risk scores were assessed. We compared the predictive value of NT-proBNP to both risk scores and evaluated whether NT-proBNP improves prognostication by using receiver operator curves and measures of discrimination improvement.Results: A total of 1324 patients were included and 50 patients died during follow-up. On logistic regression analysis NT-proBNP and the GRACE risk score (but not the TIMI risk score) both independently predicted mortality at 30 days. The predictive value of NT-proBNP did not differ significantly compared to the GRACE risk score (area under the curve [AUC]) 0.85 vs 0.87 p=0.67) but was considerably higher in comparison to the TIMI risk score (AUC 0.60 p<0.001). Adjustment of the GRACE risk score by adding NT-proBNP did not improve prognostication: AUC 0.86 (p=0.57), integrated discrimination improvement 0.04 (p=0.003), net reclassification improvement 0.12 (p=0.21).Conclusion: In patients with NSTE-ACS, NT-proBNP and the GRACE risk score (but not the TIMI risk score) both have good and comparable predictive value for 30-day mortality. However, incremental prognostic value of NT-proBNP beyond the GRACE risk score could not be demonstrated. Keywords: myocardial infarction, NSTE-ACS, NT-proBNP, GRACE risk score, TIMI risk score

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