NT-proBNP voorspelt sterfte na een STEMI, onafhankelijk van de ejectiefractie

<sec><st>Background</st> <p>Biomarkers could improve risk stratification in patients with acute ST-segment elevation myocardial infarction (STEMI), beyond left ventricular ejection fraction (LVEF). Our study evaluated the association between N-terminal pro-B-type natriuretic peptide (NT-proBNP), C reactive protein (CRP) and mortality in a cohort of patients with acute STEMI.</p> </sec> <sec><st>Methods</st> <p>This prospective, observational cohort study included patients with reperfused acute STEMI admitted to a tertiary cardiovascular disease centre between July 2020 and October 2023. All patients underwent NT-proBNP and CRP testing. The association between NT-proBNP, CRP and all-cause mortality was evaluated in relation to predischarge LVEF.</p> </sec> <sec><st>Results</st> <p>The cohort included 566 patients with a mean age of 63 years. After a median follow-up of 39 months, postdischarge all-cause mortality reached 13.4%. NT-proBNP was associated with mortality irrespective of LVEF (HR 2.34 per SD increment in log NT-proBNP; p&lt;0.001 at LVEF &lt;50% and HR 2.36; p=0.004 at LVEF &ge;50%), but the association between CRP and mortality was significant only in patients with LVEF &lt;50% (HR 1.55, p=0.003). Across the cohort, NT-proBNP remained associated with death after adjustment for age, sex, diabetes, baseline high-sensitivity cardiac troponin T (hs-cTnT), CRP, final Thrombolysis in myocardial infarction (TIMI) flow grade and reduced LVEF (HR 1.45, p=0.03). In patients with preserved LVEF, routine NT-proBNP testing (area under the curve (AUC) 0.753 (0.642&ndash;0.863), p&lt;0.001) improved risk stratification compared with isolated LVEF assessment (AUC 0.592 (0.453&ndash;0.730), p=0.18).</p> </sec> <sec><st>Conclusions</st> <p>In a cohort of stabilised acute STEMI survivors, NT-proBNP was associated with all-cause mid-term mortality independent of hs-cTnT and LVEF. The association between CRP and mortality was significant only in patients with LVEF &lt;50%.</p> </sec>