Diagnostic and prognostic value of NT-proBNP in patients undergoing coronary angiography

T. Schupp (Mannheim)¹, P. Steinke (Mannheim)¹, L. Kuhn (Mannheim)², M. Abumayyaleh (Mannheim)¹, K. J. Weidner (Mannheim)¹, T. Bertsch (Nürnberg)³, I. Akin (Mannheim)¹, M. Behnes (Mannheim)^1
1Universitätsklinikum Mannheim GmbH I. Medizinische Klinik Mannheim, Deutschland; ²Universitätsklinikum Mannheim I. Medizinische Klinik Mannheim, Deutschland; ³Klinikum Nürnberg Nord Institut für klinische Chemie und Laboratoriumsmedizin und Transfusionsmedizin Nürnberg, Deutschland

Objective: The study investigates the diagnostic and prognostic value of N-terminal prohormone of brain natriuretic peptide (NT-proBNP) in unselected patients undergoing invasive coronary angiography (CA).

Background: Related to ongoing demographic changes and improved treatment strategies for patients with cardiovascular disease, the spectrum of patients undergoing CA has significantly changed during the past decades, leading to a higher proportion of patients with comorbidities and multi-morbidity.

Methods: Consecutive patients undergoing invasive CA from 2016 to 2022 were included at one institution. Receiver operating characteristic (ROC) analyses were performed to investigate the predictive value of NT-proBNP regarding the discrimination of acute decompensated heart failure (ADHF). In line, the prognostic value of NT-proBNP was tested for 30-day all-cause mortality. ROC analyses, Kaplan-Meier and multivariable Cox regression analyses were performed.

Results: From 2016 to 2022, 2,890 patients undergoing CA were included (ADHF: 22.8%). With an area under the curve (AOC) of 0.728, NT-proBNP displayed moderate diagnostic accuracy with regard to the presence of ADHF on admission. In patients with ADHF, a NT-proBNP levels of 4413 pg/ml was the optimal cut-off to predict 30-day all-cause mortality with a corresponding sensitivity of 66.1% and specificity of 72.4%. Patients with higher NT-proBNP levels were associated with an increased risk of 30-day all-cause mortality (17.1% vs. 4.1%; log rank p = 0.001; HR = 2.941; 95% CI 2.239 – 3.862; p = 0.001), which was still observed after multivariable adjustment (HR = 1.416; 95% CI 1.225 – 1.817; p = 0.048).

Conclusion: NT-proBNP was associated with reliable diagnostic and moderate prognostic discrimination in unselected patients undergoing CA.