Prognostic Value Of NT-proBNP Complements The GEACE Score In People With Non-ST-Segment Elevation Acute Coronary Syndrome

Objectives:This study was designed to investigate whether admission N-terminal pro-brain natriuretic peptide (NT-proBNP) increase the prognostic accuracy of Global Registry of Acute Cornary Events(GRACE) risk score in the prediction of short-term prognosis after non-ST-segment acute coronary syndrome(NSTE-ACS).Background:Accurate risk stratification soon after admission for patients with NSTE-ACS is vital in guiding management. GRACE risk scores and NT-proBNP can predict short-term and long-term prognosis in NSTE-ACS, but it is unknown whether NT-proBNP improves GRACE scores prediction performance.Method:A total of126patients with unstable angina84(66.7%) and non-ST-segment elevation elevation myocardial infarction42(33.3%) were studied and followed up to30days. Admission GRACE score and NT-proBNP levels were measured. The primary endpoint was30days incidence of major adverse cardiac events (cardiac death, recurrent ischemia or myocardial infarction, unplanned revascularization, new onset of congestive heart failure). Patients were divided into endpoints group and non-endpoints group. The receiver operating characteristic (ROC) curve was used to evaluate prognostic value of NT-proBNP level and GRACE score.Results:During the follow up,14primary endpoints were recorded including8recurrent ischemia or myocardial (57.2%).3unplanned revascularization(21.4%) and3new onset of congestive heart failure(21.4%) and no cardiac death. The systolic blood pressure was significantly lower while heart rate, left ventricular ejection fraction(LVEF), Killip grading were significantly higher in the endpoints group than in non-endpoints group. The lgNT-proBNP level at admission and GRACE score were significantly higer in the endpoints group than in non-endpoints group (all P<O.001). In the logistic regression model, NT-proBNP and GRACE score were independent predictors of endpoints in the patients with NSTE-ACS. After GRACE risk stratification, lgNT-proBNP of high risk group was the highest among the three groups (P<0.001). According to NT-proBNP lecels, patients were stratified into four groups by quartile. Compared with lowest, second, and third quartiles, the GRACE risk score was the highest in the fourth quartile (P<O.001). The lgNT-proBNP in patients with NSTE-ACS had positive correlation with their GRACE risk score(r=0.30, P<O.001). The prognostic criteria for NT-proBNP level (area under cure,0.47) was608pg/ml determined by ROC (P<O001). For GRACE score, the predictive value for endpoints was0.718(P=0.001) and the cut-off point was156. Addition of NT-proBNP to the GRACE score, the predictive value for endpoints was O.825(P<O.O01).Conclusions:Both NT-proBNP level at admission and GRACE score were independent predictors for endpoints at30days in patients with NSTE-ACS. The prognostic criteria for NT-proBNP level was608pg/ml. For GRACE score, the cut-off point was156. Plasma NT-proBNP level refine the accuracy of the GRACE score.