Article Impact Level: HIGH Data Quality: STRONG Summary of Clinical Cardiology, 46(7), 810–817. https://doi.org/10.1002/clc.24037 Dr. Xuefei Mu et al.
Points
- The study aims to improve the prognosis for patients with both acute coronary syndrome (ACS) and atrial fibrillation (AF) by assessing the utility of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in combination with the CHA2DS2-VASc score.
- A cohort of 1223 patients with baseline NT-proBNP measurements from January 2016 to December 2019 was examined, with primary outcomes centered on 12-month all-cause death and secondary outcomes involving cardiac death and major adverse cardiovascular and cerebrovascular events (MACCE).
- Elevated NT-proBNP levels were strongly associated with increased risks of all-cause death, cardiac death, and MACCE, as indicated by adjusted hazard ratios (HR) and 95% confidence intervals (CI).
- Notably, combining NT-proBNP with the CHA2DS2-VASc score significantly improved prognostic accuracy, with substantial increases in the area under the curve (AUC) for predicting long-term risks of all-cause mortality, cardiac death, and MACCE.
- The study concludes that NT-proBNP is a valuable biomarker when used with the CHA2DS2-VASc score. It offers a promising approach to identify high-risk patients better and enhance their management in the context of ACS and AF.
Summary
In this research paper, the authors tackle the critical challenge of identifying high-risk patients with acute coronary syndrome (ACS) and atrial fibrillation (AF) to optimize their prognostic management. The central hypothesis explored in the study is whether the inclusion of N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels can enhance the predictive value for long-term cardiovascular events beyond the CHA2DS2-VASc score in this specific patient population.
The study encompassed a cohort of 1223 patients with documented NT-proBNP measurements collected between January 2016 and December 2019 to investigate this hypothesis. The primary study endpoint focused on all-cause death at the 12-month mark, while secondary outcomes included 12-month cardiac death and major adverse cardiovascular and cerebrovascular events (MACCE). MACCE was a composite of all-cause death, myocardial infarction, or stroke.
The results of the investigation underscored a compelling association between elevated serum levels of NT-proBNP and heightened risks of all-cause death (adjusted hazard ratio [HR]: 1.05, 95% confidence interval [CI], 1.03–1.07), cardiac death (adjusted HR: 1.05, 95% CI, 1.03–1.07), and MACCE (adjusted HR: 1.04, 95% CI, 1.02–1.06). The notable finding was that the prognostic accuracy of the CHA2DS2-VASc score was significantly improved when integrated with NT-proBNP. This combined approach resulted in a noteworthy increment of 9%, 11%, and 7% in the discrimination of long-term risk for all-cause mortality (area under the curve [AUC]: from 0.64 to 0.73), cardiac death (AUC: from 0.65 to 0.76), and MACCE (AUC: from 0.62 to 0.69), respectively.
Link to the article: https://onlinelibrary.wiley.com/doi/10.1002/clc.24037
References Mu, X., Qiu, M., Li, Y., Li, Z., Qi, B., Jing, Z., & Jing, Q. (2023). N‐terminal pro‐B‐type natriuretic peptide improves the predictive value of CHA 2 DS 2 ‐VASc risk score for long‐term cardiovascular events in acute coronary syndrome patients with atrial fibrillation. Clinical Cardiology, 46(7), 810–817. https://doi.org/10.1002/clc.24037
