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

• Published in: Vascular health and risk management Vol. 12; pp. 471 - 476
• Main Authors: Schellings, Dirk Aam, Adiyaman, Ahmet, Dambrink, Jan-Henk E, Gosselink, At Marcel, Kedhi, Elvin, Roolvink, Vincent, Ottervanger, Jan Paul, Van't Hof, Arnoud Wj
• Format: Journal Article
• Language: English
• Published: New Zealand Taylor & Francis Ltd 01.01.2016; Dove Medical Press
• Subjects: Acute Coronary Syndrome - blood; Acute Coronary Syndrome - diagnosis; Acute Coronary Syndrome - mortality; Acute coronary syndromes; Aged; Aged, 80 and over; Area Under Curve; Biomarkers; Biomarkers - blood; Cardiology; Cardiovascular disease; Coronary Angiography; Decision Support Techniques; Electrocardiography; Female; GRACE risk score; Heart attacks; Humans; Logistic Models; Male; Middle Aged; Mortality; Myocardial infarction; Natriuretic Peptide, Brain - blood; Non-ST Elevated Myocardial Infarction - blood; Non-ST Elevated Myocardial Infarction - diagnosis; Non-ST Elevated Myocardial Infarction - mortality; NSTE-ACS; NT-proBNP; Odds Ratio; Original Research; Patients; Peptide Fragments - blood; Peptides; Predictive Value of Tests; Prognosis; Registries; Retrospective Studies; Risk Assessment; Risk Factors; ROC Curve; Time Factors; TIMI risk score; Netherlands; TIMI risk score; NSTE-ACS; NT-proBNP; GRACE risk score; myocardial infarction
• ISSN: 1178-2048; 1176-6344; 1178-2048
• DOI: 10.2147/VHRM.S117204

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. 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. 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. 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 =0.67) but was considerably higher in comparison to the TIMI risk score (AUC 0.60 <0.001). Adjustment of the GRACE risk score by adding NT-proBNP did not improve prognostication: AUC 0.86 ( =0.57), integrated discrimination improvement 0.04 ( =0.003), net reclassification improvement 0.12 ( =0.21). 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.