Prognostic Value of NT-proBNP versus Killip Classification in Patients with Acute Coronary Syndromes
Abstract Background: Plasma levels of brain natriuretic peptides have better diagnostic accuracy compared to clinical-radiologic judgment for acute heart failure. In acute coronary syndromes (ACS), the prognostic value of acute heart failure is incorporated into predictive models through Killip cla...
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| Format: | Article |
| Language: | English |
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Sociedade Brasileira de Cardiologia (SBC)
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| Series: | Arquivos Brasileiros de Cardiologia |
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| Online Access: | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0066-782X2020000400666&lng=en&tlng=en |
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| author | Thiago M. B. Souza Antônio Maurício S. Cerqueira Jr. Jessica G. Suerdieck Nicole C. de Sá Gabriella S. Sodré Vitor C. A. Correia Yasmin F. Lacerda Leticia L. Fonseca Marcia M. Noya-Rabelo Luis C. L. Correia |
| author_facet | Thiago M. B. Souza Antônio Maurício S. Cerqueira Jr. Jessica G. Suerdieck Nicole C. de Sá Gabriella S. Sodré Vitor C. A. Correia Yasmin F. Lacerda Leticia L. Fonseca Marcia M. Noya-Rabelo Luis C. L. Correia |
| author_sort | Thiago M. B. Souza |
| collection | DOAJ |
| description | Abstract Background: Plasma levels of brain natriuretic peptides have better diagnostic accuracy compared to clinical-radiologic judgment for acute heart failure. In acute coronary syndromes (ACS), the prognostic value of acute heart failure is incorporated into predictive models through Killip classification. It is not established whether NT-proBNP could increment prognostic prediction. Objective: To evaluate whether NT-proBNP, as a measure of left ventricular dysfunction, improves the in-hospital prognostic value of the GRACE score in ACS. Methods: Patients admitted due to acute chest pain, with electrocardiogram and/or troponin criteria for ACS were included in the study. The plasma level of NT-proBNP was measured at hospital admission and the primary endpoint was defined as cardiovascular death during hospitalization. P-value < 0.05 was considered as significant. Results: Among 352 patients studied, cardiovascular mortality was 4.8%. The predictive value of NT-proBNP for cardiovascular death was shown by a C-statistic of 0.78 (95% CI = 0.65-0.90). After adjustment for the GRACE model subtracted by Killip variable, NT-proBNP remained independently associated with cardiovascular death (p = 0.015). However, discrimination by the GRACE-BNP logistic model (C-statistics = 0.83; 95%CI = 0.69-0.97) was not superior to the traditional GRACE Score with Killip (C-statistic = 0.82; 95%CI = 0.68-0.97). The GRACE-BNP model did not provide improvement in the classification of patients to high risk by the GRACE Score (net reclassification index = - 0.15; p = 0.14). Conclusion: Despite the statistical association with cardiovascular death, there was no evidence that NT-proBNP increments the prognostic value of GRACE score in ACS. |
| first_indexed | 2024-12-22T03:30:36Z |
| format | Article |
| id | doaj.art-533cd76ecfd54f07b207d1e89ad43354 |
| institution | Directory Open Access Journal |
| issn | 0066-782X 1678-4170 |
| language | English |
| last_indexed | 2024-12-22T03:30:36Z |
| publisher | Sociedade Brasileira de Cardiologia (SBC) |
| record_format | Article |
| series | Arquivos Brasileiros de Cardiologia |
| spelling | doaj.art-533cd76ecfd54f07b207d1e89ad433542022-12-21T18:40:31ZengSociedade Brasileira de Cardiologia (SBC)Arquivos Brasileiros de Cardiologia0066-782X1678-4170114466667210.36660/abc.20180345S0066-782X2020000400666Prognostic Value of NT-proBNP versus Killip Classification in Patients with Acute Coronary SyndromesThiago M. B. SouzaAntônio Maurício S. Cerqueira Jr.Jessica G. SuerdieckNicole C. de SáGabriella S. SodréVitor C. A. CorreiaYasmin F. LacerdaLeticia L. FonsecaMarcia M. Noya-RabeloLuis C. L. CorreiaAbstract Background: Plasma levels of brain natriuretic peptides have better diagnostic accuracy compared to clinical-radiologic judgment for acute heart failure. In acute coronary syndromes (ACS), the prognostic value of acute heart failure is incorporated into predictive models through Killip classification. It is not established whether NT-proBNP could increment prognostic prediction. Objective: To evaluate whether NT-proBNP, as a measure of left ventricular dysfunction, improves the in-hospital prognostic value of the GRACE score in ACS. Methods: Patients admitted due to acute chest pain, with electrocardiogram and/or troponin criteria for ACS were included in the study. The plasma level of NT-proBNP was measured at hospital admission and the primary endpoint was defined as cardiovascular death during hospitalization. P-value < 0.05 was considered as significant. Results: Among 352 patients studied, cardiovascular mortality was 4.8%. The predictive value of NT-proBNP for cardiovascular death was shown by a C-statistic of 0.78 (95% CI = 0.65-0.90). After adjustment for the GRACE model subtracted by Killip variable, NT-proBNP remained independently associated with cardiovascular death (p = 0.015). However, discrimination by the GRACE-BNP logistic model (C-statistics = 0.83; 95%CI = 0.69-0.97) was not superior to the traditional GRACE Score with Killip (C-statistic = 0.82; 95%CI = 0.68-0.97). The GRACE-BNP model did not provide improvement in the classification of patients to high risk by the GRACE Score (net reclassification index = - 0.15; p = 0.14). Conclusion: Despite the statistical association with cardiovascular death, there was no evidence that NT-proBNP increments the prognostic value of GRACE score in ACS.http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0066-782X2020000400666&lng=en&tlng=enacute coronary syndromeheart failurenatriuretic peptide, brainmortalityventricular dysfunction, leftbiomarkers |
| spellingShingle | Thiago M. B. Souza Antônio Maurício S. Cerqueira Jr. Jessica G. Suerdieck Nicole C. de Sá Gabriella S. Sodré Vitor C. A. Correia Yasmin F. Lacerda Leticia L. Fonseca Marcia M. Noya-Rabelo Luis C. L. Correia Prognostic Value of NT-proBNP versus Killip Classification in Patients with Acute Coronary Syndromes Arquivos Brasileiros de Cardiologia acute coronary syndrome heart failure natriuretic peptide, brain mortality ventricular dysfunction, left biomarkers |
| title | Prognostic Value of NT-proBNP versus Killip Classification in Patients with Acute Coronary Syndromes |
| title_full | Prognostic Value of NT-proBNP versus Killip Classification in Patients with Acute Coronary Syndromes |
| title_fullStr | Prognostic Value of NT-proBNP versus Killip Classification in Patients with Acute Coronary Syndromes |
| title_full_unstemmed | Prognostic Value of NT-proBNP versus Killip Classification in Patients with Acute Coronary Syndromes |
| title_short | Prognostic Value of NT-proBNP versus Killip Classification in Patients with Acute Coronary Syndromes |
| title_sort | prognostic value of nt probnp versus killip classification in patients with acute coronary syndromes |
| topic | acute coronary syndrome heart failure natriuretic peptide, brain mortality ventricular dysfunction, left biomarkers |
| url | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0066-782X2020000400666&lng=en&tlng=en |
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