Wang Man, Cao Ning, Zhou Li, Su Wen, Chen Hui, Li Hongwei
Department of Cardiology, Cardiovascular Centre, Beijing Friendship Hospital, Capital Medical University, No.95, Yongan Road, Xicheng District, Beijing, 100050, People's Republic of China.
Beijing Key Laboratory of Metabolic Disorder Related Cardiovascular Disease, Beijing, China.
Diabetol Metab Syndr. 2023 Oct 6;15(1):192. doi: 10.1186/s13098-023-01163-1.
The prognostic value of N-terminal pro-B-type natriuretic peptide (NT-proBNP) across body mass index (BMI) categories in patients with acute myocardial infarction (AMI) is unclear. We aimed to assess the predictive value of NT-proBNP levels and identify the best cutoff values for mortality risk prediction across BMI categories in AMI.
We analyzed 4677 patients with AMI from the Cardiovascular Centre Beijing Friendship Hospital Database Bank. Patients were classified into underweight (< 18.5 kg/m), normal-weight (18.5-23.9 kg/m), overweight (24-27.9 kg/m), and obese (≥ 28 kg/m) groups. The association between NT-proBNP (ln-transformed) and mortality was investigated using Cox regression and stratified by BMI.
During follow-up (13,787 person-years of observation), 718 patients died, averaging 52.1 events per 1000 person-years. NT-proBNP levels were inversely correlated with BMI (β = - 0.096, P < 0.001). After adjustment, NT-proBNP was independently associated with all-cause mortality (hazard ratio [HR] per 1-SD: 1.82; 95% confidence interval [CI] 1.60-2.07) in patients with AMI. Similar findings were observed in analyses stratified by BMI category, except for the underweight group. Adding NT-proBNP to conventional risk models improved risk discrimination in normal-weight, overweight, and obese patients (C-index changes of 0.036, 0.042, and 0.032, respectively) and classification of patients into predicted mortality risk categories (net reclassification improvement 0.263, 0.204, and 0.197, respectively). The best NT-proBNP cutoff values for 5-year mortality risk prediction across BMI categories were 5710, 4492, 2253, and 1300 pg/ml.
NT-proBNP level was an independent prognostic factor for mortality in patients with AMI and varied according to BMI. The best NT-proBNP cutoff values for mortality risk prediction reduced as BMI increased.
急性心肌梗死（AMI）患者中，N末端B型利钠肽原（NT-proBNP）在不同体重指数（BMI）类别中的预后价值尚不清楚。我们旨在评估NT-proBNP水平的预测价值，并确定AMI患者不同BMI类别中死亡风险预测的最佳临界值。
我们分析了北京友谊医院心血管中心数据库中的4677例AMI患者。患者被分为体重过轻（<18.5kg/m²）、正常体重（18.5-23.9kg/m²）、超重（24-27.9kg/m²）和肥胖（≥28kg/m²）组。使用Cox回归研究NT-proBNP（对数转换）与死亡率之间的关联，并按BMI进行分层。
在随访期间（13787人年的观察），718例患者死亡，每1000人年平均发生52.1起事件。NT-proBNP水平与BMI呈负相关（β=-0.096，P<0.001）。调整后，NT-proBNP与AMI患者的全因死亡率独立相关（每1标准差的风险比[HR]：1.82；95%置信区间[CI]1.60-2.07）。在按BMI类别分层的分析中观察到类似结果，但体重过轻组除外。将NT-proBNP添加到传统风险模型中可改善正常体重、超重和肥胖患者的风险辨别能力（C指数变化分别为0.036、0.042和0.032），并将患者分类为预测死亡风险类别（净重新分类改善分别为0.263、0.204和0.197）。不同BMI类别5年死亡风险预测的最佳NT-proBNP临界值分别为5710、4492、2253和1300pg/ml。
NT-proBNP水平是AMI患者死亡的独立预后因素，并随BMI而异。死亡风险预测的最佳NT-proBNP临界值随BMI增加而降低。
