N-terminal pro-B-type natriuretic peptide and the risk of stroke among patients hospitalized with acute heart failure: an APEX trial substudy.


Journal Article

Among patients hospitalized with acute heart failure (HF), the prognostic value of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in short-term stroke prediction remains unclear.In the APEX trial, 7513 patients hospitalized for an acute medical illness were randomized to receive either extended-duration betrixaban (80 mg once daily for 35-42 days) or standard-of-care enoxaparin (40 mg once daily for 10 ± 4 days) for venous thromboprophylaxis. Baseline NT-proBNP concentrations were obtained in 3261 patients admitted for HF. Stroke events were adjudicated by an independent clinical events committee blinded to thromboprophylaxis allocation. The association of NT-proBNP level and other risk factors and biomarkers with stroke was assessed at 77 days after randomization.In univariate analysis, the risk of stroke at 77 days was associated with baseline NT-proBNP (HR 3.63 [95% CI 1.47-8.99]; P = 0.005), D-dimer (HR 2.73 [95% CI 1.03-7.20]; P = 0.043), and hsCRP (HR 3.03 [95% CI 1.36-6.75]; P = 0.007). In multivariable analysis adjusting for hsCRP and thromboprophylaxis, NT-proBNP was associated with the risk of stroke (adjusted HR 3.64 [95% CI 1.35-9.83]; P = 0.011). The interaction of NT-proBNP with the treatment effect was not significant (Pint = 0.30).Baseline NT-proBNP concentration was associated with short-term stroke among patients hospitalized with acute HF. Stroke risk assessment models should consider incorporation of NT-proBNP measurement.

Full Text

Duke Authors

Cited Authors

  • Chi, G; Januzzi, JL; Korjian, S; Daaboul, Y; Goldhaber, SZ; Hernandez, AF; Hull, RD; Gold, A; Cohen, AT; Harrington, RA; Gibson, CM

Published Date

  • November 2017

Published In

Volume / Issue

  • 44 / 4

Start / End Page

  • 457 - 465

PubMed ID

  • 28905172

Pubmed Central ID

  • 28905172

Electronic International Standard Serial Number (EISSN)

  • 1573-742X

International Standard Serial Number (ISSN)

  • 0929-5305

Digital Object Identifier (DOI)

  • 10.1007/s11239-017-1552-7


  • eng