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

Tobias Schupp (Mannheim)1, P. Steinke (Mannheim)1, L. Kuhn (Mannheim)1, M. Abumayyaleh (Mannheim)1, K. J. Weidner (Mannheim)1, T. Bertsch (Nürnberg)2, I. Akin (Mannheim)1, M. Behnes (Mannheim)1

1Universitätsklinikum Mannheim I. Medizinische Klinik Mannheim, Deutschland; 2Klinikum Nürnberg Nord Institut für klinische Chemie und Laboratoriumsmedizin und Transfusionsmedizin Nürnberg, Deutschland


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. 
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