N-terminal pro B type natriuretic peptide complements the GRACE risk score in predicting early and late mortality following acute coronary syndrome

Sohail Q Khan (1) , Hafid Narayan , Kelvin H Ng , Onkar S Dhillon , Dominic Kelly , Paulene Quinn , Iain B Squire , Joan E Davies , Leong L Ng

1 Department of Cardiovascular Sciences [Leicester]

Background: The GRACE risk score has been shown to offer predictive power with regards to death and myocardial infarction (AMI) in patients with acute coronary syndromes (ACS). N-terminal pro-B type natriuretic peptide (NT-proBNP) has also been found to be useful in predicting mortality following ACS. Aim: We sought to investigate the utility of GRACE score and NT-proBNP levels at predicting risk of early and late deaths following ACS. Method: We studied 1033 patients (740 men, mean age 66.5 ± 12.7years) with AMI. Blood was drawn once within 24 hours following the onset of chest pain. The plasma concentration of NT-proBNP was determined using an in-house non-competitive immunoassay. Results: Patients were GRACE risk scored as described. 30-day mortality was 3.7%, 6-month mortality was 7.8%, all were related to higher GRACE risk scores (p=0.001 for trend). Higher NT-proBNP levels were also related to increased mortality (p<0.0001). In a Cox proportional hazards model, independent predictors of 30-day and 6-month mortality included NT-proBNP levels and GRACE risk score. The receiver-operating curve for GRACE risk score was complemented by NT-proBNP levels for prediction of 30-day mortality (AUC 0.85) and 6-month mortality (AUC 0.81). Conclusion: NT-proBNP gives complementary information to GRACE risk score for predicting early and late mortality. The inclusion of the NT-proBNP blood test is useful in risk stratifying patients after an acute coronary syndrome.

Mots clés: Medicine

Sohail Q Khan, Hafid Narayan, Kelvin H Ng, Onkar S Dhillon, Dominic Kelly, et al.. N-terminal pro B type natriuretic peptide complements the GRACE risk score in predicting early and late mortality following acute coronary syndrome. Clinical Science, 2009, 117 (1), pp.31-39. ⟨10.1042/CS20080419⟩. ⟨hal-00488425⟩