[Relationship between plasma N-terminal pro-brain natriuretic peptide and GRACE risk stratification in non-ST-segment elevation acute coronary syndrome]

Abstract

Objective: To explore the relationship between plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) level obtained on admission and global registry of acute coronary events (GRACE) scores and the value for risk stratification in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS).

Methods: A total of 231 NSTE-ACS patients admitted in our hospital between June 2009 and September 2010 were included [161 patients with unstable angina (UA) and 70 patients with non-ST-segment elevation myocardial infarction (NSTEMI)]. On admission plasma NT-proBNP was measured in all patients. The GRACE risk score were used for risk assessment. Patients were followed up for 6 months and incidence of new or recurrent myocardial infarction, target vessel revascularization, cardiac death, heart failure (MACE) was recorded.

Results: According to GRACE risk stratification, there were 62 low-risk patients, 78 middle-risk patients and 91 high-risk patients. lgNT-proBNP level on admission increased in proportion to increasing risk defined by GRACE risk stratification and lgNT-proBNP positively correlated with GRACE risk score (r = 0.59, P < 0.001). The GRACE risk score was the highest in the fourth NT-proBNP quartile (P < 0.001 vs. lowest, second and third quartiles). GRACE score was significantly higher in patients with NT-proBNP level above the 75 percentile compared patients with NT-proBNP under the 75 percentile (P < 0.001). MACE occurred in 9 [3.9% (9/231)] patients during follow up. ROC analysis showed AUC of on admission NT-proBNP was 0.831 (SE = 0.062, P = 0.001, 95%CI 0.711 - 0.952) and AUC of GRACE risk score was 0.799 (SE = 0.079, P = 0.002, 95%CI 0.644 - 0.954) for predicting the short-term risk of MACE (P = 0.75).

Conclusion: On admission plasma NT-proBNP level parallels GRACE risk score in NSTE-ACS patients, both on admission plasma NT-proBNP level and GRACE risk score are valuable parameters for risk stratification in patients with NSTE-ACS and increased NT-proBNP level and GRACE values are predictors for increased short-term risk of MACE.