Moreover, most studies have been conducted in white populations and remain to be validated in Asian populations. While there are established cut-off values for the association between GRACE risk scores and in-hospital mortality, there is no clear cut-off value for NT-proBNP to guide risk stratification in patients with AMI. The 2020 European Society of Cardiology guideline on the management of acute coronary syndrome (ACS) states that measurement of brain natriuretic peptide (BNP) or NT-proBNP plasma concentrations should be considered to obtain prognostic information (class IIa, level of evidence B). However, its role for risk stratification in AMI remains debatable. N-terminal pro brain natriuretic peptide (NT-proBNP) is an established biomarker for the diagnosis of heart failure. 1 Other predictors, including reduced left ventricular ejection fraction (LVEF) and poor recovery of LVEF after AMI, have also been long recognised in risk stratification for patients with AMI. The Thrombolysis in MI (TIMI) and Global Registry of Acute Coronary Events (GRACE) risk scores have been demonstrated to have reasonably good discriminatory value, including in Asian populations. Risk stratification and prognostication is an important step for the management of acute MI (AMI). Randomised controlled trials are needed to further validate the usefulness of NT-proBNP for risk stratification in patients with AMI. Conclusion: NT-proBNP level ≥1,995 pg/ml measured within 24 hours of admission for AMI was associated with higher all-cause mortality at 1 year. There were no significant differences among the predictive values of NT-proBNP, Thrombolysis in MI risk score, Global Registry of Acute Coronary Events risk score and left ventricular ejection fraction in predicting all-cause mortality at 1 year (p>0.05). Using the Youden index, an NT-proBNP level ≥1,995 pg/ml was an independent predictor of all-cause mortality at 1 year (adjusted HR 2.6 95% CI p=0.010), regardless of cardiovascular disease risk factors or revascularisation status. NT-proBNP ≥404 pg/ml had an area under the curve of 0.66 (95% CI p=0.004) to predict all-cause mortality at 1 year (sensitivity 80.6% specificity 36.9% positive predictive value 9.47% negative predictive value 95.89%). Results: One-year all-cause mortality occurred in 31 (7.6%) of 411 patients. Plasma NT-proBNP was assessed within 24 hours of admission. Methods: We conducted a multicentre, prospective, observational study involving 411 patients admitted for AMI. Our study sought to evaluate the cut-off values of NT-proBNP in all-cause mortality post AMI and to compare with other available risk assessment scores. While there are established cut-off values for the association between clinical risk assessment scores and in-hospital mortality, there is no clear cut-off value for NT-proBNP to guide risk stratification in patients with acute MI (AMI). Background: N-terminal pro-brain natriuretic peptide (NT-proBNP) provides prognostic information regarding the risk of death, acute heart failure and the development of AF in patients with acute coronary syndrome.
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