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.
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.
['Schellings|Dirk Aam|DA|', 'Adiyaman|Ahmet|A|', 'Dambrink|Jan-Henk E|JE|', 'Gosselink|At Marcel|AM|', 'Kedhi|Elvin|E|', 'Roolvink|Vincent|V|', 'Ottervanger|Jan Paul|JP|', "Van't Hof|Arnoud Wj|AW|"]
D054058:Acute Coronary Syndrome D000368:Aged D000369:Aged, 80 and over D019540:Area Under Curve D015415:Biomarkers D017023:Coronary Angiography D003661:Decision Support Techniques D005260:Female D006801:Humans D016015:Logistic Models D008297:Male D008875:Middle Aged D020097:Natriuretic Peptide, Brain D000072658:Non-ST Elevated Myocardial Infarction D016017:Odds Ratio D010446:Peptide Fragments D011237:Predictive Value of Tests D011379:Prognosis D012372:ROC Curve D012042:Registries D012189:Retrospective Studies D018570:Risk Assessment D012307:Risk Factors D013997:Time Factors
NT-proBNP TIMI risk score NSTE-ACS myocardial infarction GRACE risk score