NT-proBNP to guide risk stratification after cardiac rehabilitation in patients with ST-segment elevation myocardial infarction

Fecha de publicación: 01/07/2025 Fecha Ahead of Print: 01/06/2025

Grupos y Plataformas de I+D+i

Grupo de investigación en Cardiología Clínica

Leading Researcher

Juan Sanchis Fores
Grupo de Investigación en Electrofisiología cardiaca experimental

Leading Researcher

Antonio M. Alberola Aguilar
Grupo de Investigación en Insuficiencia Cardiaca

Established Researcher

Julio Nuñez Villota
Grupo de Investigación Traslacional en Cardiopatía Isquémica

Leading Researcher

Vicent Bodí Peris

Abstract

Introduction and objectives The use of N-terminal pro-brain natriuretic peptide (NT-proBNP) after ST-segment elevation acute myocardial infarction (STEMI) is unclear. We evaluated its prognostic significance after post-STEMI cardiac rehabilitation. Methods The prognostic significance of NT-proBNP was tested upon completion of cardiac rehabilitation (median, 45 days post-STEMI) in an exploratory group (n = 105 patients with the researchers blinded to NT-proBNP values) and validated in the following 276 patients. Baseline and cardiac imaging variables including cardiovascular magnetic resonance (CMR) parameters were recorded. The primary endpoint was the occurrence of a first major adverse cardiac event (MACE: cardiac death, myocardial infarction, or re-admission for heart failure). Results In the exploratory group, a cut-off value of NT-proBNP >400 pg/mL emerged as a potent MACE predictor (37 % vs.17 %; hazard ratio [HR]: 6.8 [1.5-30.3], p = 0.01). In the study group, during a 203-week median follow-up, 88 (32 %) first MACEs were detected. NT-proBNP >400 pg/mL (n = 168, 61 %) associated with a higher MACE rate (46 % vs. 10 %, HR: 4.6 [2.3-8.9], p < 0.001) and, separately, with more cardiac deaths, myocardial infarctions, and re-admissions for heart failure (p < 0.05 for all comparisons). NT-proBNP improved the multivariate model for MACE prediction (area under the curve 0.81 vs. 0.72, p < 0.001). Conclusions Even after comprehensive adjustment, NT-proBNP emerges as a potent, accessible and inexpensive tool for risk stratification of STEMI patients after completion of rehabilitation programs.