Abstract:BackgroundThe Zwolle Risk Score (ZRS) identifies ST‐elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (PPCI) eligible for early discharge. We aimed to investigate whether baseline N‐terminal pro–brain natriuretic peptide (NT‐proBNP) is also able to identify these patients and could improve future risk strategies.Methods and ResultsPPCI patients included in the Ongoing Tirofiban in Myocardial Infarction Evaluation (On‐TIME) II study were candidates (N=861).… Show more
“…Previous studies highlighted that, in patients with STEMI, NT-proBNP, drawn within 24 hours of the onset of chest pain, is more accurate in predicting mortality than the TIMI risk score 26. Indeed, our group recently revealed that baseline NT-proBNP values predict 30-day mortality in patients with STEMI, treated with primary PCI independently and even more strongly than the Zwolle risk score alone 27. However, in patients with STEMI the prognostic value of NT-proBNP on long-term, 5-year mortality outcomes to date has never been reported.…”
“…Previous studies highlighted that, in patients with STEMI, NT-proBNP, drawn within 24 hours of the onset of chest pain, is more accurate in predicting mortality than the TIMI risk score 26. Indeed, our group recently revealed that baseline NT-proBNP values predict 30-day mortality in patients with STEMI, treated with primary PCI independently and even more strongly than the Zwolle risk score alone 27. However, in patients with STEMI the prognostic value of NT-proBNP on long-term, 5-year mortality outcomes to date has never been reported.…”
“…In patients with STEMI, previous MI, door to balloon time, the presence of diabetes, anemia, chronic renal failure, and ejection fraction on admission are the main predictors of mortality. Risk scores such as TIMI, GRACE, PAMI, Zwolle, or CADILLAC are commonly applied as mortality indicators (3)(4)(5)(6)13,14). Beyond clinical data, angiographic data are also used to predict the longterm prognosis, such as the SYNTAX score (15).…”
Section: Discussionmentioning
confidence: 99%
“…Therefore, risk stratification is essential for clinical decision and management. Various risk scores such as Thrombolysis in Myocardial Infarction (TIMI), GRACE, and ZWOLLE have been applied (3)(4)(5). Besides angiographic variables, clinical data, such as the presence of anemia and renal impairment, are independent risk factors for in-hospital cardiovascular mortality.…”
“…1). Recently, we demonstrated that the predictive accuracy of the ZRS was improved by adding baseline NT-proBNP [12]. In this report we studied the value of NT-proBNP measurement at different timepoints over and beyond the ZRS.Fig.…”
BackgroundThe Zwolle Risk Score (ZRS) identifies primary percutaneous coronary intervention (PPCI) patients at low mortality risk, eligible for early discharge. Recently, this score was improved by adding baseline NT-proBNP. However, the optimal timepoint for NT-proBNP measurement is unknown.MethodsPPCI patients in the On-Time 2 study were candidates. The ZRS and NT-proBNP levels on admission, at 18–24 h, at 72–96 h, and the change in NT-proBNP from baseline to 18–24 h (delta NT-proBNP) were determined. We investigated whether addition of the different NT-proBNP measurements to the ZRS improves the prediction of 30-day mortality. Based on cut-off values reflecting zero mortality at 30 d, patients who potentially could be discharged early were identified and occurrence of major adverse cardiac events (MACE) and major bleeding until 10 d was registered.Results845 patients were included. On multivariate analyses, NT-proBNP at baseline (HR 2.09, 95% CI 1.59–2.74, p < 0.001), at 18–24 h (HR 6.83, 95% CI 2.94–15.84), and at 72–96 h (HR 3.32, 95% CI 1.22–9.06) independently predicted death at 30 d. Addition of NT-proBNP to the ZRS improved prediction of mortality, particularly at 18–24 h (net reclassification index 29%, p < 0.0001, integrated discrimination improvement 17%, p < 0.0001). Based on ZRS (<2) or NT-proBNP at 18–24 h (<2500 pg/ml) 75% of patients could be targeted for early discharge at 48 h, with expected re-admission rates of 1.2% due to MACE and/or major bleeding.ConclusionsNT-proBNP at different timepoints improves prognostication of the ZRS. Particularly at 18–24 h post PPCI, the largest group of patients that potentially could be discharged early was identified.Electronic supplementary materialThe online version of this article (doi: 10.1007/s12471-016-0935-2) contains supplementary material, which is available to authorized users.
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