Predictive value of N-terminal pro-brain natriuretic peptide for short-term prognosis of patients with acute myocardial infarction

Objective To evaluate the prognostic performance of N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with acute ST elevation myocardial infarction(STEMI). Methods NT-proBNP was obtained from 204 patients with STEMI in Fuwai Hospital within 1-3 day after admission. The patients were divided into two groups: Group 1 with cardiac events,including death,cardiogenic shock and heart failure; Group 2 without cardiac events. Death occurred in 7 patients,heart failure occurred in 53 patients,and cardiogenic shock occurred in 13 patients. Results Compared with patients in group 2,NT-proBNP,age,the prevalences of diabetes and multivessel were significantly higher in group 1 (P0.05); and left ventricular ejection fraction (LVEF),the prevalences of male and smoking rate were significantly lower (P0.05). The areas under ROC curve of NT-proBNP,CK-MB,TnT,LVEF,LVEDD to predict cardiac event were 0.756,0.525,0.536,0.694,and 0.519,respectively. Only LVEF and NT-proBNP had predictive values for the patients (all P 0.01). The optimal cutoff value of NT-proBNP to predict cardiac event was 762 fmol/mL,with a sensitivity of 75.9% and a specificity of 63.3%; the positive predictive value was 42.7% and the negative predictive value was 88.0%,with an accuracy of 66.7%. Patients with NT-proBNP concentration above 762 fmol/mL had a higher rate of cardiac event,heart failure,cardiogenic shock and death (42.7% vs. 12.0%,41.7% vs. 12.0%,10.4% vs. 2.8%,and 6.3% vs. 0.9%,all P0.05). Variables associated with cardiac event in univariate analysis included NT-proBNP,LVEF,age,sex,smoking and diabetes. After adjustment for the above variables using multi regression logistic model,NT-proBNP,age,LVEF,and diabetes remained to be the dependent factors for prediction of cardiac events. Conclusion NT-proBNP can predict the short term outcomes of STEMI patients.