Title |
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
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Published in |
Vascular Health and Risk Management, November 2016
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DOI | 10.2147/vhrm.s117204 |
Pubmed ID | |
Authors |
Dirk AAM Schellings, Ahmet Adiyaman, Jan-Henk E Dambrink, AT Marcel Gosselink, Elvin Kedhi, Vincent Roolvink, Jan Paul Ottervanger, Arnoud WJ van’t Hof |
Abstract |
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. 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. 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. 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). 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. |
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Unknown | 1 | 100% |
Demographic breakdown
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Members of the public | 1 | 100% |
Mendeley readers
Geographical breakdown
Country | Count | As % |
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Unknown | 30 | 100% |
Demographic breakdown
Readers by professional status | Count | As % |
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Researcher | 5 | 17% |
Student > Postgraduate | 3 | 10% |
Student > Ph. D. Student | 3 | 10% |
Other | 2 | 7% |
Student > Master | 2 | 7% |
Other | 3 | 10% |
Unknown | 12 | 40% |
Readers by discipline | Count | As % |
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Medicine and Dentistry | 12 | 40% |
Biochemistry, Genetics and Molecular Biology | 2 | 7% |
Nursing and Health Professions | 1 | 3% |
Arts and Humanities | 1 | 3% |
Immunology and Microbiology | 1 | 3% |
Other | 1 | 3% |
Unknown | 12 | 40% |