NT-proBNP in the Early Convalescent Phase after High-Risk Myocardial Infarction Is Associated with Adverse Cardiovascular Outcomes: the PARADISE-MI Trial.

BACKGROUND: N-terminal pro-B-type natriuretic peptide (NT-proBNP) is associated with heart failure (HF) hospitalizations and death when measured during a myocardial infarction (MI). However, NT-proBNP concentrations change following the initial ischemic insult and less is known about the prognostic importance of NT-proBNP in the early convalescent phase. METHODS: PARADISE-MI randomized 5661 patients with MI complicated by LVEF ≤40% and/or pulmonary congestion to sacubitril/valsartan or ramipril. Patients with available week 2 NT-proBNP concentrations and without-incident HF between randomization and week 2 (n = 1062) were analyzed. Associations of week 2 NT-proBNP with subsequent clinical outcomes were evaluated in landmark analyses using Cox models adjusted for clinical characteristics, including LVEF, baseline NT-proBNP and atrial fibrillation. RESULTS: Median 2-week NT-proBNP concentration was 1391 [676-2507] ng/L. Patients in the highest NT-proBNP quartile (≥2507 ng/L) were older, had lower left ventricular ejection fraction (LVEF) and estimated glomerular filtration rate (eGFR), higher Killip class, and more atrial fibrillation. Higher NT-proBNP concentrations were independently associated with greater risk of cardiovascular death or incident HF (adjusted hazard ratio [aHR], 1.65 per doubling of NT-proBNP; 95% confidence interval [CI], 1.31-2.09), HF hospitalization (aHR, 1.87; 95% CI, 1.38-2.54), recurrent myocardial infarction (aHR, 1.46; 95% CI, 1.09-1.95) and all-cause death (aHR, 1.85; 95% CI, 1.35-2.53). CONCLUSIONS: Patients with elevated NT-proBNP concentrations approximately 2 weeks after a high-risk myocardial infarction are at heightened risk of incident HF, recurrent coronary events, and death independent of baseline NT-proBNP concentrations and clinical characteristics. Elevations in NT-proBNP concentrations in the early convalescent phase may assist in risk stratification and the identification of patients in need of more advanced preventive treatment approaches.

Duke Scholars

Author Christopher Bull Granger Medicine, Cardiology