Author + information
- JaeHyuk Jang1,
- Young Kyoung Sa2,
- Kwan Yong Lee3,
- Mineok Chang4,
- Doo soo Jeon5,
- Young Su Lee4 and
- ByungHo Kim4
- 1Cardiovascular Center and Cardiology Division, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea, Republic of
- 2Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea, Republic of
- 3Seoul st. mary's hospital, Seoul, Korea, Republic of
- 4Seoul St. Mary's hospital, Seoul, Korea, Republic of
- 5Incheon St. Mary's hospital, Seoul, Korea, Republic of
The ACEF (age, creatinine, and ejection fraction) score and NT-proBNP (N-terminal pro-B-type natriuretic peptide) has been established to be useful in predicting mortality following acute coronary syndrome(ACS). However, there are few data exists in patients with acute myocardial infarction(AMI). We aimed to investigate the use of the ACEF score and NT-proBNP levels at predicting risk of long term mortality after AMI.
We consecutively enrolled AMI patients who underwent percutaneous coronary intervention (PCI) between January 2004 and December 2009 from nine university hospitals throughout South Korea. Patients were ACEF scored and the plasma concentration of NT-proBNP was determined. The primary endpoint was all-cause mortality during a median follow-up of 3.38 years.
Of 3217 patients, the all-cause mortality was 18.59% and it was significantly related to higher ACEF scores (p<0.001 for trend). Higher NT-pro BNP level was associated with increased mortality(p<0.001 for trend). In a Cox proportional hazards model, the independent predictors of all-cause death included the ACEF score[adjusted HR 1.829, 95% CI 1.603-2.087; P<0.001] and NT-proBNP[adjusted HR 1.657, 95% CI 1.461-1.879; p<0.001]. When NT-proBNP was added to the individual components of the ACEF score, it displaced many of the factors in the score. The Kaplan-Meier survival curve related to whether the patients had a below- or above-median ACEF score and a below or above-median NT-proBNP level (pooled over strata, log rank 301.8, p<0.001). The combination of ACEF score and NT-proBNP improved risk prediction for mortality [AUC, 0.75 (95% CI, 0.734-0.765); p<0.001], which significantly exceeded that of ACEF score and NT-proBNP(p<0.001 for all).
NT pro BNP gives complementary information to the ACEF score for predicting long term mortality. The inclusion of the NT-proBNP level is useful in risk-stratifying patients following AMI.
STRUCTURAL: Heart Failure