TY - JOUR
T1 - NT-proBNP in the Early Convalescent Phase after High-Risk Myocardial Infarction Is Associated with Adverse Cardiovascular Outcomes
T2 - the PARADISE-MI Trial
AU - Jering, Karola S
AU - Claggett, Brian L
AU - Braunwald, Eugene
AU - Granger, Christopher B
AU - Køber, Lars
AU - Landmesser, Ulf
AU - Lewis, Eldrin F
AU - Maggioni, Aldo P
AU - Mann, Douglas L
AU - McMurray, John Jv
AU - Mehran, Roxana
AU - Petrie, Mark C
AU - Prescott, Margaret F
AU - Rouleau, Jean L
AU - Schou, Morten
AU - Solomon, Scott D
AU - Steg, Phillippe Gabriel
AU - von Lewinski, Dirk
AU - Pfeffer, Marc A
N1 - Copyright © 2025. Published by Elsevier Inc.
PY - 2025/4/16
Y1 - 2025/4/16
N2 - BACKGROUND: N-terminal pro-B-type natriuretic peptide (NT-proBNP) is associated with heart failure (HF) hospitalizations and death when measured during a myocardial infarction (MI). However, NT-proBNP concentrations change following the initial ischemic insult and less is known about the prognostic importance of NT-proBNP in the early convalescent phase.METHODS: PARADISE-MI randomized 5661 patients with MI complicated by LVEF ≤40% and/or pulmonary congestion to sacubitril/valsartan or ramipril. Patients with available week 2 NT-proBNP concentrations and without-incident HF between randomization and week 2 (n = 1062) were analyzed. Associations of week 2 NT-proBNP with subsequent clinical outcomes were evaluated in landmark analyses using Cox models adjusted for clinical characteristics, including LVEF, baseline NT-proBNP and atrial fibrillation.RESULTS: Median 2-week NT-proBNP concentration was 1391 [676-2507] ng/L. Patients in the highest NT-proBNP quartile (≥2507 ng/L) were older, had lower left ventricular ejection fraction (LVEF) and estimated glomerular filtration rate (eGFR), higher Killip class, and more atrial fibrillation. Higher NT-proBNP concentrations were independently associated with greater risk of cardiovascular death or incident HF (adjusted hazard ratio [aHR], 1.65 per doubling of NT-proBNP; 95% confidence interval [CI], 1.31-2.09), HF hospitalization (aHR, 1.87; 95% CI, 1.38-2.54), recurrent myocardial infarction (aHR, 1.46; 95% CI, 1.09-1.95) and all-cause death (aHR, 1.85; 95% CI, 1.35-2.53).CONCLUSIONS: Patients with elevated NT-proBNP concentrations approximately 2 weeks after a high-risk myocardial infarction are at heightened risk of incident HF, recurrent coronary events, and death independent of baseline NT-proBNP concentrations and clinical characteristics. Elevations in NT-proBNP concentrations in the early convalescent phase may assist in risk stratification and the identification of patients in need of more advanced preventive treatment approaches.
AB - BACKGROUND: N-terminal pro-B-type natriuretic peptide (NT-proBNP) is associated with heart failure (HF) hospitalizations and death when measured during a myocardial infarction (MI). However, NT-proBNP concentrations change following the initial ischemic insult and less is known about the prognostic importance of NT-proBNP in the early convalescent phase.METHODS: PARADISE-MI randomized 5661 patients with MI complicated by LVEF ≤40% and/or pulmonary congestion to sacubitril/valsartan or ramipril. Patients with available week 2 NT-proBNP concentrations and without-incident HF between randomization and week 2 (n = 1062) were analyzed. Associations of week 2 NT-proBNP with subsequent clinical outcomes were evaluated in landmark analyses using Cox models adjusted for clinical characteristics, including LVEF, baseline NT-proBNP and atrial fibrillation.RESULTS: Median 2-week NT-proBNP concentration was 1391 [676-2507] ng/L. Patients in the highest NT-proBNP quartile (≥2507 ng/L) were older, had lower left ventricular ejection fraction (LVEF) and estimated glomerular filtration rate (eGFR), higher Killip class, and more atrial fibrillation. Higher NT-proBNP concentrations were independently associated with greater risk of cardiovascular death or incident HF (adjusted hazard ratio [aHR], 1.65 per doubling of NT-proBNP; 95% confidence interval [CI], 1.31-2.09), HF hospitalization (aHR, 1.87; 95% CI, 1.38-2.54), recurrent myocardial infarction (aHR, 1.46; 95% CI, 1.09-1.95) and all-cause death (aHR, 1.85; 95% CI, 1.35-2.53).CONCLUSIONS: Patients with elevated NT-proBNP concentrations approximately 2 weeks after a high-risk myocardial infarction are at heightened risk of incident HF, recurrent coronary events, and death independent of baseline NT-proBNP concentrations and clinical characteristics. Elevations in NT-proBNP concentrations in the early convalescent phase may assist in risk stratification and the identification of patients in need of more advanced preventive treatment approaches.
UR - http://www.scopus.com/inward/record.url?scp=105005804580&partnerID=8YFLogxK
U2 - 10.1016/j.cardfail.2025.03.018
DO - 10.1016/j.cardfail.2025.03.018
M3 - Journal article
C2 - 40250826
SN - 1071-9164
JO - Journal of Cardiac Failure
JF - Journal of Cardiac Failure
ER -