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

*geplaatst 2026-01-16 · Algemeen · Open Heart · doi http://openheart.bmj.com/cgi/content/short/13/1/e003845?rss=1 · https://hartvaat.nl/2026/01/16/nt-probnp-voorspelt-sterfte-na-een-stemi-onafhankelijk-van-de-ejectiefractie/*

Biomarkers kunnen de risico-inschatting na een ST-elevatie-myocardinfarct (STEMI) verbeteren, voorbij de ejectiefractie (LVEF). Deze prospectieve studie (566 patiënten met gereperfundeerd STEMI, 2020-2023) onderzocht het verband tussen NT-proBNP, CRP en sterfte. Na een mediane follow-up van 39 maanden was de sterfte 13,4%. NT-proBNP was geassocieerd met sterfte ongeacht de LVEF (HR ~2,3 per standaarddeviatie), terwijl CRP alleen voorspellend was bij een LVEF <50% (HR 1,55). NT-proBNP bleef geassocieerd met sterfte na correctie voor leeftijd, geslacht, diabetes, troponine, TIMI-flow en verminderde LVEF. Bij patiënten met een behouden ejectiefractie verbeterde routinematige NT-proBNP-bepaling de risico-inschatting duidelijk ten opzichte van de LVEF alleen (AUC 0,75 vs. 0,59). NT-proBNP is dus een waardevolle, onafhankelijke prognostische marker na een STEMI.

## English: Prognostic value of N-terminal pro-B-type natriuretic peptide and C reactive protein testing in patients with acute ST-segment elevation myocardial infarction

Biomarkers can improve risk stratification after ST-elevation myocardial infarction (STEMI), beyond ejection fraction (LVEF). This prospective study (566 patients with reperfused STEMI, 2020-2023) examined the relationship between NT-proBNP, CRP and mortality. After a median follow-up of 39 months, mortality was 13.4%. NT-proBNP was associated with mortality regardless of LVEF (HR ~2.3 per standard deviation), whereas CRP was predictive only at LVEF <50% (HR 1.55). NT-proBNP remained associated with mortality after adjustment for age, sex, diabetes, troponin, TIMI flow and reduced LVEF. In patients with preserved ejection fraction, routine NT-proBNP testing clearly improved risk stratification over LVEF alone (AUC 0.75 vs 0.59). NT-proBNP is thus a valuable, independent prognostic marker after STEMI.

## Abstract (original, from the publication)

<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>

Auteurs: Dregoesc, I. M., Cramariuc, D., Wilsgaard, T., Istrate, M., Buiga, V. S., Ichim, S., Ober, C., Manole, S., Sharashova, E., Stylidis, M., Hung, J., Iancu, A. C., Bleie, O., Steigen, T.

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Bron: Open Heart, https://doi.org/http://openheart.bmj.com/cgi/content/short/13/1/e003845?rss=1. Bijgewerkt 2026-07-03T13:31:25Z. Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.