PROGNOSTIC VALUE OF PLASMA NT-PROBNP IN ACUTE MYOCARDIAL INFARCTION
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Abstract
Background: Acute myocardial infarction (AMI) is a common cardiovascular emergency with high rates of mortality and complications. N-terminal pro–B-type natriuretic peptide (NT-proBNP) is a biomarker reflecting left ventricular dysfunction; however, data on its in-hospital prognostic value in the Vietnamese population remain limited.
Objective: To determine the association between plasma NT-proBNP levels at hospital admission and in-hospital mortality in patients with AMI.
Methods: A retrospective study was conducted on 399 patients with AMI admitted to Nguyen Trai Hospital (Ho Chi Minh City) between January 2022 and October 2024, who had NT-proBNP measured within the first 24 hours of admission. Factors associated with in-hospital mortality were analyzed using logistic regression. The NT-proBNP cutoff value was determined by receiver operating characteristic (ROC) curve analysis based on the Youden index.
Results: Among 399 patients (mean age 66 ± 11.7 years, 56.6% male), the rate of in-hospital death was 13.3%. Patients with mortality were older (71.4 vs. 65.3 years; p < 0.001), had higher rates of dyslipidemia (43.4% vs. 28%; p = 0.02), lower ejection fraction (42% vs. 48%; p = 0.003), faster heart rate (104.3 vs. 86.4 bpm; p < 0.001), and significantly higher NT-proBNP levels (6931 vs. 1818.5 pg/mL; p < 0.001). The rate of coronary stent placement was markedly lower in the mortality group (41.5% vs. 58.1%; p = 0.02). ROC analysis identified an optimal NT-proBNP cutoff of 3276 pg/mL to predict in-hospital mortality, with an AUC = 0.73, sensitivity 77.4%, specificity 67.3%, and accuracy 68.7%. Patients with NT-proBNP ≥ 3276 pg/mL had an event rate of 26.6%, approximately five times higher than those with lower NT-proBNP levels (4.9%; p < 0.001).
Conclusion: Plasma NT-proBNP is an independent predictor of in-hospital mortality among patients with acute myocardial infarction. The cutoff value of 3276 pg/mL allows early risk stratification, particularly valuable in tertiary hospitals where patients are often older and have multiple comorbidities. These findings support integrating NT-proBNP testing into early risk assessment protocols for AMI management in Vietnam.
Keywords
Acute myocardial infarction, NT-proBNP, in-hospital prognosis
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References
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