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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

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

Received 14 July 2016

Accepted for publication 24 August 2016

Published 21 November 2016 Volume 2016:12 Pages 471—476


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Daniel A. Duprez

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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