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Prognostic Importance of NT-proBNP (N-Terminal Pro-B-Type Natriuretic Peptide) Following High-Risk Myocardial Infarction in the PARADISE-MI Trial.

Publication ,  Journal Article
Jering, KS; Claggett, BL; Pfeffer, MA; Granger, CB; Køber, L; Lewis, EF; Maggioni, AP; Mann, DL; McMurray, JJV; Prescott, MF; Rouleau, JL ...
Published in: Circ Heart Fail
May 2023

BACKGROUND: NT-proBNP (N-terminal pro-B-type natriuretic peptide) is a potent predictor of death and heart failure (HF) across multiple populations. We evaluated the prognostic importance of NT-proBNP in patients with acute myocardial infarction (MI) complicated by left ventricular systolic dysfunction, pulmonary congestion, or both and ≥1 of 8 risk-augmenting factors enrolled in the PARADISE-MI trial (Prospective ARNI vs ACE Inhibitor Trial to Determine Superiority in Reducing Heart Failure Events After Myocardial Infarction). METHODS: Patients were randomized to sacubitril/valsartan 200 mg or ramipril 5 mg twice daily within 0.5 to 7 days of a MI. Patients with prior HF were excluded. NT-proBNP and hs-cTnT (high-sensitivity troponin T) were collected at randomization in a prespecified substudy of 1129 patients. The primary end point of PARADISE-MI was a composite of cardiovascular death or incident HF (hospitalization or outpatient symptomatic HF), analyzed as time-to-first event; additional end points included all-cause death and the composite of fatal or nonfatal MI or stroke. RESULTS: Median NT-proBNP was 1757 ng/L (25th-75th percentiles, 896-3462 ng/L) at randomization (4.0±1.8 days after the index MI). Patients in the highest quartile of NT-proBNP were older, more commonly women and had more hypertension, atrial fibrillation, renal dysfunction, and pulmonary congestion on presentation (all P<0.001). NT-proBNP was strongly associated with the primary end point (adjusted hazard ratio, 1.45 per doubling of NT-proBNP; [95% CI, 1.23-1.70]), adjusted for clinical variables and baseline hs-cTnT. NT-proBNP was also independently associated with all-cause death (adjusted hazard ratio, 1.74 [95% CI, 1.38-2.21]) and fatal or nonfatal MI or stroke (adjusted hazard ratio, 1.24 [95% CI, 1.05-1.45]). NT-proBNP did not significantly modify the neutral treatment effect of sacubitril/valsartan relative to ramipril (P interaction=0.46). CONCLUSIONS: Within the first week of a high-risk MI NT-proBNP is associated with incident HF, death and atherosclerotic events. This prognostic information is independent of hs-cTnT. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT02924727.

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Published In

Circ Heart Fail

DOI

EISSN

1941-3297

Publication Date

May 2023

Volume

16

Issue

5

Start / End Page

e010259

Location

United States

Related Subject Headings

  • Valsartan
  • Ramipril
  • Prospective Studies
  • Prognosis
  • Peptide Fragments
  • Natriuretic Peptide, Brain
  • Myocardial Infarction
  • Humans
  • Heart Failure
  • Female
 

Citation

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Jering, K. S., Claggett, B. L., Pfeffer, M. A., Granger, C. B., Køber, L., Lewis, E. F., … Braunwald, E. (2023). Prognostic Importance of NT-proBNP (N-Terminal Pro-B-Type Natriuretic Peptide) Following High-Risk Myocardial Infarction in the PARADISE-MI Trial. Circ Heart Fail, 16(5), e010259. https://doi.org/10.1161/CIRCHEARTFAILURE.122.010259
Jering, Karola S., Brian L. Claggett, Marc A. Pfeffer, Christopher B. Granger, Lars Køber, Eldrin F. Lewis, Aldo P. Maggioni, et al. “Prognostic Importance of NT-proBNP (N-Terminal Pro-B-Type Natriuretic Peptide) Following High-Risk Myocardial Infarction in the PARADISE-MI Trial.Circ Heart Fail 16, no. 5 (May 2023): e010259. https://doi.org/10.1161/CIRCHEARTFAILURE.122.010259.
Jering KS, Claggett BL, Pfeffer MA, Granger CB, Køber L, Lewis EF, et al. Prognostic Importance of NT-proBNP (N-Terminal Pro-B-Type Natriuretic Peptide) Following High-Risk Myocardial Infarction in the PARADISE-MI Trial. Circ Heart Fail. 2023 May;16(5):e010259.
Jering, Karola S., et al. “Prognostic Importance of NT-proBNP (N-Terminal Pro-B-Type Natriuretic Peptide) Following High-Risk Myocardial Infarction in the PARADISE-MI Trial.Circ Heart Fail, vol. 16, no. 5, May 2023, p. e010259. Pubmed, doi:10.1161/CIRCHEARTFAILURE.122.010259.
Jering KS, Claggett BL, Pfeffer MA, Granger CB, Køber L, Lewis EF, Maggioni AP, Mann DL, McMurray JJV, Prescott MF, Rouleau JL, Solomon SD, Steg PG, von Lewinski D, Braunwald E. Prognostic Importance of NT-proBNP (N-Terminal Pro-B-Type Natriuretic Peptide) Following High-Risk Myocardial Infarction in the PARADISE-MI Trial. Circ Heart Fail. 2023 May;16(5):e010259.

Published In

Circ Heart Fail

DOI

EISSN

1941-3297

Publication Date

May 2023

Volume

16

Issue

5

Start / End Page

e010259

Location

United States

Related Subject Headings

  • Valsartan
  • Ramipril
  • Prospective Studies
  • Prognosis
  • Peptide Fragments
  • Natriuretic Peptide, Brain
  • Myocardial Infarction
  • Humans
  • Heart Failure
  • Female