Pérez-Solé Nerea, de Dios Elena, Gavara José, Ríos-Navarro César, Marcos-Garces Víctor, Merenciano Héctor, Climent Josefina I, López-Bueno Laura, Payá Alfonso, de la Espriella Rafael, Bayés-Genís Antoni, Jiménez-Navarro Manuel, Marín Francisco, Núnez Julio, Sanchis Juan, Bodí Vicente
Instituto de Investigación Sanitaria INCLIVA, Valencia, , España; Centro de Investigación Biomédica en Red - Cardiovascular (CIBER-CV), Madrid, España.
Centro de Investigación Biomédica en Red - Cardiovascular (CIBER-CV), Madrid, España.
Eur J Intern Med. 2025 Jul;137:83-89. doi: 10.1016/j.ejim.2025.04.027. Epub 2025 May 1.
The use of N-terminal pro-brain natriuretic peptide (NT-proBNP) after ST-segment elevation acute myocardial infarction (STEMI) is unclear. We evaluated its prognostic significance after post-STEMI cardiac rehabilitation.
The prognostic significance of NT-proBNP was tested upon completion of cardiac rehabilitation (median, 45 days post-STEMI) in an exploratory group (n = 105 patients with the researchers blinded to NT-proBNP values) and validated in the following 276 patients. Baseline and cardiac imaging variables including cardiovascular magnetic resonance (CMR) parameters were recorded. The primary endpoint was the occurrence of a first major adverse cardiac event (MACE: cardiac death, myocardial infarction, or re-admission for heart failure).
In the exploratory group, a cut-off value of NT-proBNP >400 pg/mL emerged as a potent MACE predictor (37 % vs.17 %; hazard ratio [HR]: 6.8 [1.5-30.3], p = 0.01). In the study group, during a 203-week median follow-up, 88 (32 %) first MACEs were detected. NT-proBNP >400 pg/mL (n = 168, 61 %) associated with a higher MACE rate (46 % vs. 10 %, HR: 4.6 [2.3-8.9], p < 0.001) and, separately, with more cardiac deaths, myocardial infarctions, and re-admissions for heart failure (p < 0.05 for all comparisons). NT-proBNP improved the multivariate model for MACE prediction (area under the curve 0.81 vs. 0.72, p < 0.001).
Even after comprehensive adjustment, NT-proBNP emerges as a potent, accessible and inexpensive tool for risk stratification of STEMI patients after completion of rehabilitation programs.
ST段抬高型急性心肌梗死（STEMI）后N末端脑钠肽前体（NT-proBNP）的应用尚不清楚。我们评估了其在STEMI后心脏康复后的预后意义。
在一个探索性队列（n = 105例患者，研究人员对NT-proBNP值不知情）中，于心脏康复完成时（STEMI后中位时间45天）检测NT-proBNP的预后意义，并在随后的276例患者中进行验证。记录包括心血管磁共振（CMR）参数在内的基线和心脏成像变量。主要终点是首次发生的主要不良心脏事件（MACE：心源性死亡、心肌梗死或因心力衰竭再次入院）。
在探索性队列中，NT-proBNP>400 pg/mL的临界值成为有力的MACE预测指标（37%对17%；风险比[HR]：6.8[1.5 - 30.3]，p = 0.01）。在研究队列中，在中位203周的随访期间，检测到88例（32%）首次MACE。NT-proBNP>400 pg/mL（n = 168，61%）与更高的MACE发生率相关（46%对10%，HR：4.6[2.3 - 8.9]，p < 0.001），并且分别与更多的心源性死亡、心肌梗死和因心力衰竭再次入院相关（所有比较p < 0.05）。NT-proBNP改善了MACE预测的多变量模型（曲线下面积0.81对0.72，p < 0.001）。
即使经过全面调整，NT-proBNP仍是康复计划完成后对STEMI患者进行风险分层的有力、可及且廉价的工具。
