NT-proBNP measured soon after heart attack may predict poor outcomes
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Key takeaways:
- NT-proBNP may predict CV death, incident HF and fatal or nonfatal CV events after acute MI.
- The association was independent of high-sensitivity troponin T level.
N-terminal pro-B-type natriuretic peptide level soon after acute MI may be prognostic of CV death or incident HF, independent of high-sensitivity troponin T, researchers reported.
This prespecified post hoc analysis of the PARADISE-MI trial was published in Circulation: Heart Failure.
Image: Adobe Stock
“MI remains one of the leading causes of morbidity and mortality in the world, accounting for >15 million deaths per year. Following an acute MI, patients are at heightened risk of further MI, stroke, development of HF and death, especially sudden death. Yet even after high-risk MI, only a minority of patients experiences these events emphasizing the potential value of risk stratification to guide post-MI surveillance and treatment,” Karola S. Jering, MD, cardiologist at the Carl J. and Ruth Shapiro Cardiovascular Center at Brigham and Women's Hospital, Heart and Vascular Center, and colleagues wrote. “Therefore, we have investigated the relationship between NT-proBNP and a range of cardiovascular outcomes in a prespecified biomarker substudy of the PARADISE-MI trial.”
The results of the PARADISE-MI trial
PARADISE-MI was a randomized, double-blind, parallel trial that evaluated the superiority of sacubitril/valsartan (Entresto, Novartis) compared with ramipril for the prevention of HF events in 5,669 patients with acute MI.
As Healio | Cardiology Today previously reported, sacubitril/valsartan did not significantly lower the rate of CV death or incident HF after acute MI compared with ramipril.
For this prespecified substudy of PARADISE-MI, researchers evaluated NT-proBNP and high-sensitivity troponin T that were collected at randomization in a subgroup of 1,129 patients.
The primary endpoint was a composite of CV death or incident HF — defined as hospitalization or outpatient HF requiring treatment — analyzed as time to first event. Additional endpoints included all-cause death and the composite of fatal or nonfatal MI or stroke.
Participants were stratified in quartiles of NT-proBNP: first quartile, 896 ng/L or less; second quartile, 897 ng/L to 1,757 ng/L; third quartile, 1,758 ng/L to 3,462 ng/L; and fourth quartile, greater than 3,462 ng/L.
Prognostic value of NT-proBNP after acute MI
Median NT-proBNP was 1,757 ng/L at trial randomization and participants were followed up during a median 29 months.
Researchers observed that patients in the fourth quartile of NT-proBNP were older, more often women and had more hypertension, atrial fibrillation, renal dysfunction and pulmonary congestion on presentation (P for all < .001), according to the study.
After adjusting for clinical variables and baseline high-sensitivity troponin T, Jering and colleagues reported that for every doubling of NT-proBNP, they observed an approximately 45% increased risk for the primary composite endpoint (adjusted HR = 1.45; 95% CI, 1.23-1.7).
NT-proBNP was also independently associated with all-cause death (aHR = 1.74; 95% CI, 1.38-2.21) and fatal or nonfatal MI or stroke (aHR = 1.24; 95% CI, 1.05-1.45), according to the study.
Moreover, NT-proBNP did not significantly modify the neutral treatment effect of sacubitril/valsartan relative to ramipril (P for interaction = .46), researchers reported.
“Elevations in NT-proBNP measured early after acute MI were associated with risk of subsequent nonfatal and fatal cardiovascular events, independent of clinical characteristics and high-sensitivity troponin T,” the researchers wrote. “How risk stratification based on NT-proBNP can guide management strategies requires further study. The relative treatment effect of sacubitril/valsartan compared with ramipril in PARADISE-MI was not significantly modified by concentrations of NT-proBNP at randomization although this substudy was not powered to detect differential treatment effects according to NT-proBNP concentrations.”
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