NT-proBNP to guide risk stratification after cardiac rehabilitation in patients with ST-segment elevation myocardial infarction

Introduction and objectives The use of N-terminal pro-brain natriuretic peptide (NT-proBNP) after ST-segment elevation acute myocardial infarction (STEMI) is unclear. We evaluated its prognostic significance after post-STEMI cardiac rehabilitation. Methods The prognostic significance of NT-proBNP wa...

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Detalles Bibliográficos
Autores: Pérez-Solé N, De Dios E, Gavara J, Ríos-Navarro C, Marcos-Garces V, Merenciano H, Bertolín C, Climent JI, López-Bueno L, Payá A, Bonanad C, Cánoves J, Monmeneu JV, López-Lereu MP, Miñana G, De la Espriella R, Ventura A, Bayés-Genís A, Rodríguez-Capitán J, Jiménez-Navarro M, Martínez-Dolz L, Marín F, Chorro FJ, Núnez J, Sanchis J, Bodí V
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2025
País:España
Institución:INCLIVA
Repositorio:r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
OAI Identifier:oai:incliva.fundanetsuite.com:p20044
Acceso en línea:https://incliva.portalinvestigacion.com/publicaciones/20044
Access Level:acceso abierto
Palabra clave:St-segment elevation myocardial infarction
N-terminal pro-brain natriuretic peptide
Cardiovascular magnetic resonance
Prognosis
Rehabilitation
Descripción
Sumario:Introduction and objectives The use of N-terminal pro-brain natriuretic peptide (NT-proBNP) after ST-segment elevation acute myocardial infarction (STEMI) is unclear. We evaluated its prognostic significance after post-STEMI cardiac rehabilitation. Methods The prognostic significance of NT-proBNP was tested upon completion of cardiac rehabilitation (median, 45 days post-STEMI) in an exploratory group (n = 105 patients with the researchers blinded to NT-proBNP values) and validated in the following 276 patients. Baseline and cardiac imaging variables including cardiovascular magnetic resonance (CMR) parameters were recorded. The primary endpoint was the occurrence of a first major adverse cardiac event (MACE: cardiac death, myocardial infarction, or re-admission for heart failure). Results In the exploratory group, a cut-off value of NT-proBNP >400 pg/mL emerged as a potent MACE predictor (37 % vs.17 %; hazard ratio [HR]: 6.8 [1.5-30.3], p = 0.01). In the study group, during a 203-week median follow-up, 88 (32 %) first MACEs were detected. NT-proBNP >400 pg/mL (n = 168, 61 %) associated with a higher MACE rate (46 % vs. 10 %, HR: 4.6 [2.3-8.9], p < 0.001) and, separately, with more cardiac deaths, myocardial infarctions, and re-admissions for heart failure (p < 0.05 for all comparisons). NT-proBNP improved the multivariate model for MACE prediction (area under the curve 0.81 vs. 0.72, p < 0.001). Conclusions Even after comprehensive adjustment, NT-proBNP emerges as a potent, accessible and inexpensive tool for risk stratification of STEMI patients after completion of rehabilitation programs.

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