The prognostic role of N-terminal prohormone brain natriuretic peptide and TIMI risk score in patients with ST segment elevation myocardial infarction

TANG Hai-lian; TANG Zhao-li; MEI Lin; LUO Chang-jun

摘要：Background ST segment elevation myocardial infarction (STEMI) remains a major cause of death worldwide. The thrombolysis in myocardial infarction (TIMI) risk score is a risk assessment tool to detect high risk STEMI patients. NT-proBNP has been used to assess the severity of heart failure. However, the predictive power of TIMI risk score is not high enough to identify all high-risk patients, and whether NT-proBNP adds power to the TIMI risk score for predicting in-hospital mortality is unclear. Methods 664 STEMI patients were included and divided into 3 groups according to TIMI risk score ≤3 (n=211), 4-6 (n=281), and ≥7 (n=172). The relation-ships between TIMI risk score and events were evaluated. The modified TIMI risk score was constructed through multivariate logistic regression analysis. Results The proportion of in-hospital death (0.5％ vs. 3.2％ vs. 10.5％, P＜0.001) and major adverse clinical events(MACEs)(14.2％ vs. 22.8％ vs. 40.1％, P＜0.001) increased as higher TIMI risk score was. ROC curve showed that the AUC of NT-proBNP for predicting in-hospital death was 0.792, with optimal cut - off being 3500pg/mL. Multivariate logistic regression analysis revealed that TIMI risk score (OR=1.26, 95％ CI 1.05-1.50, P=0.012) and NT-proBNP＞3500pg/mL (OR=7.30, 95％ CI 2.56-20.83, P＜0.001) were independently associated with in-hospital death. Adding NT-proBNP to TIMI risk score produced higher predictive value (AUC: 0.871 vs. 0.804, P=0.040). Conclusion NT-proBNP is associated with in-hospital death in STEMI patients and has an additive prognostic value to TIMI risk score.