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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.
Vasc Health Risk Manag. 2016; 12:471-476.VH

Abstract

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.

Authors+Show Affiliations

Department of Cardiology, Isala Heart Centre, Zwolle; Department of Cardiology, Slingeland Hospital, Doetinchem, the Netherlands.Department of Cardiology, Isala Heart Centre, Zwolle.Department of Cardiology, Isala Heart Centre, Zwolle.Department of Cardiology, Isala Heart Centre, Zwolle.Department of Cardiology, Isala Heart Centre, Zwolle.Department of Cardiology, Isala Heart Centre, Zwolle.Department of Cardiology, Isala Heart Centre, Zwolle.Department of Cardiology, Isala Heart Centre, Zwolle.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

27920547

Citation

Schellings, Dirk Aam, et al. "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." Vascular Health and Risk Management, vol. 12, 2016, pp. 471-476.
Schellings DA, Adiyaman A, Dambrink JE, et al. 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. Vasc Health Risk Manag. 2016;12:471-476.
Schellings, D. A., Adiyaman, A., Dambrink, J. E., Gosselink, A. M., Kedhi, E., Roolvink, V., Ottervanger, J. P., & Van't Hof, A. W. (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. Vascular Health and Risk Management, 12, 471-476.
Schellings DA, et al. 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. Vasc Health Risk Manag. 2016;12:471-476. PubMed PMID: 27920547.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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. AU - Schellings,Dirk Aam, AU - Adiyaman,Ahmet, AU - Dambrink,Jan-Henk E, AU - Gosselink,At Marcel, AU - Kedhi,Elvin, AU - Roolvink,Vincent, AU - Ottervanger,Jan Paul, AU - Van't Hof,Arnoud Wj, Y1 - 2016/11/21/ PY - 2016/12/7/entrez PY - 2016/12/7/pubmed PY - 2017/2/22/medline KW - GRACE risk score KW - NSTE-ACS KW - NT-proBNP KW - TIMI risk score KW - myocardial infarction SP - 471 EP - 476 JF - Vascular health and risk management JO - Vasc Health Risk Manag VL - 12 N2 - 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. SN - 1178-2048 UR - https://www.unboundmedicine.com/medline/citation/27920547/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_ L2 - https://dx.doi.org/10.2147/VHRM.S117204 DB - PRIME DP - Unbound Medicine ER -