急性冠状动脉综合征后利钠肽原对心力衰竭再入院的预测价值
Predictive Value of Pro-BNP for Heart Failure Readmission after an Acute Coronary Syndrome.
作者信息
Cordero Alberto, Martínez Rey-Rañal Elías, Moreno María J, Escribano David, Moreno-Arribas José, Quintanilla Maria A, Zuazola Pilar, Núñez Julio, Bertomeu-González Vicente
机构信息
Cardiology Department, Hospital Universitario de San Juan, 03550 Alicante, Spain.
Unidad de Investigación en Cardiología, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO), 46020 Valencia, Spain.
出版信息
J Clin Med. 2021 Apr 13;10(8):1653. doi: 10.3390/jcm10081653.
BACKGROUND
N-terminal pro-brain natural peptide (NT-pro-BNP) is a well-established biomarker of tissue congestion and has prognostic value in patients with heart failure (HF). Nonetheless, there is scarce evidence on its predictive capacity for HF re-admission after an acute coronary syndrome (ACS). We performed a prospective, single-center study in all patients discharged after an ACS. HF re-admission was analyzed by competing risk regression, taking all-cause mortality as a competing event. Results are presented as sub-hazard ratios (sHR). Recurrent hospitalizations were tested by negative binomial regression, and results are presented as incidence risk ratio (IRR).
RESULTS
Of the 2133 included patients, 528 (24.8%) had HF during the ACS hospitalization, and their pro-BNP levels were higher (3220 pg/mL vs. 684.2 pg/mL; < 0.001). In-hospital mortality was 2.9%, and pro-BNP was similarly higher in these patients. Increased pro-BNP levels were correlated to increased risk of HF or death during the hospitalization. Over follow-up (median 38 months) 243 (11.7%) patients had at least one hospital readmission for HF and 151 (7.1%) had more than one. Complete revascularization had a preventive effect on HF readmission, whereas several other variables were associated with higher risk. Pro-BNP was independently associated with HF admission (sHR: 1.47) and readmission (IRR: 1.45) at any age. Significant interactions were found for the predictive value of pro-BNP in women, diabetes, renal dysfunction, STEMI and patients without troponin elevation.
CONCLUSIONS
In-hospital determination of pro-BNP is an independent predictor of HF readmission after an ACS.
背景
N 末端脑钠肽前体（NT-pro-BNP）是一种公认的组织充血生物标志物，对心力衰竭（HF）患者具有预后价值。然而，关于其对急性冠状动脉综合征（ACS）后 HF 再入院的预测能力的证据很少。我们对所有 ACS 后出院的患者进行了一项前瞻性单中心研究。通过竞争风险回归分析 HF 再入院情况，将全因死亡率作为竞争事件。结果以亚危险比（sHR）表示。通过负二项回归测试再住院情况，结果以发病风险比（IRR）表示。
结果
在纳入的 2133 例患者中，528 例（24.8%）在 ACS 住院期间发生 HF，他们的脑钠肽前体水平更高（3220 pg/mL 对 684.2 pg/mL；<0.001）。住院死亡率为 2.9%，这些患者的脑钠肽前体水平同样更高。住院期间脑钠肽前体水平升高与 HF 或死亡风险增加相关。在随访期间（中位 38 个月），243 例（11.7%）患者因 HF 至少有一次再次入院，151 例（7.1%）患者有不止一次。完全血运重建对 HF 再入院有预防作用，而其他几个变量与较高风险相关。脑钠肽前体在任何年龄均与 HF 入院（sHR：1.47）和再入院（IRR：1.45）独立相关。在女性、糖尿病、肾功能不全、ST 段抬高型心肌梗死（STEMI）和肌钙蛋白未升高的患者中，发现脑钠肽前体的预测价值存在显著相互作用。
结论
住院期间测定脑钠肽前体是 ACS 后 HF 再入院的独立预测因素。
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