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Can B-type natriuretic peptide be a good predictor of in-hospital outcome in acute coronary syndrome in the presence of renal dysfunction, obesity and advanced age?
Session:
Posters 5 - Écran 01 - Isquemia/SCA
Speaker:
Silvia Aguiar
Congress:
CPC 2018
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.2 Acute Coronary Syndromes – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
Sílvia Aguiar Rosa; Ana Teresa Timóteo; Rui Cruz Ferreira; Em nome dos investigadores do Registo Nacional de Síndromes Coronárias Agudas
Abstract
<p><strong>Introduction: </strong>The prognostic value of B-type natriuretic peptide (BNP) in acute coronary syndrome (ACS) is not well studied. Moreover, BNP levels may be influenced by renal dysfunction, advanced age and obesity. The aim is to evaluate BNP as predictor of in-hospital mortality and hear failure (HF) among these groups.</p> <p><strong>Methods: </strong>Analysis of BNP admission value as predictor of in-hospital outcome in ACS patients (P). P were divided: without renal dysfunction vs renal dysfunction (creatinine > 1.2mg/dl); non-obese vs obese (body mass index > 30 kg/m<sup>2</sup>); non-elderly (<65 years) vs elderly (> 65 years).</p> <p> </p> <p><strong>Results: </strong>4387 P, 71.7% males, mean age 67±13 years.</p> <p> 826 P (18.8%) presented renal dysfunction. In this subgroup BNP showed a sensibility of 68.8% and a specificity of 59.4% to predict in-hospital mortality, with an area under the ROC curve (AUC) of 0.670, p>0.001; contrasting with subgroup without renal dysfunction (sensibility of 85.1%; specificity 61.2%; AUC 0.780; =0.022). The cut-off value of BNP as predictor of in-hospital mortality was higher in renal dysfunction P (577.5 vs 195.5 ng/ml). Regarding HF, a BNP cut-off value of 432ng/ml predicted with 77.9% of sensibility and 68.8% of specificity the occurrence of HF in P with renal dysfunction. In P without renal dysfunction the cut-off value was 250 ng/ml with 78.5% of sensibility and 76.3% of specificity. Discriminatory capacity of BNP were lower in P with renal dysfunction (AUC 0.770 vs 0.825; p=0.003).</p> <p>In 973 (22.2%) obese P, BNP sensibility to predict in-hospital mortality was 69.0% and specificity 78.3% (AUC 0.778; p<0.001), comparing to 87.4% and 54.1% respectively in non-obese (AUC 0.771; p<0.001). The cut-off value of BNP to predict death was higher in obese P (392.5 vs 196.5 ng/ml). However, the cut-off of BNP as predictor of HF was slightly lower in obese P (210 vs 250ng/ml), with similar sensibility (89.0% vs 82.2%) and specificity (74.2% vs 71.5%) comparing with non-obese. The discriminatory power of BNP for HF was superior in obese P (AUC 0.857 vs 0.823; p=0.043).</p> <p> </p> <p>2389 P (54.5%) were elderly. BNP presented a sensibility of 68.1% and a specificity of 63.0% (AUC 0.710; p<0.001) in older P comparing to a sensibility of 60.9% and a specificity of 83.9% (AUC 0.790; p<0.001) in younger P to predict in-hospital mortality. The cut-off value of BNP was higher in elderly (391.5 vs 312.5 ng/ml).</p> <p>In this subgroup the BNP cut-off value to predict HF was 304ng/ml (sensibility 81.8%; specificity 66.2%). The cut-off value in non-elderly P was 239ng/ml, with lower sensibility (70.9%) but higher specificity (83.8%). There was not significant difference in area under the ROC curve (AUC) between both models (0.798 vs 0.812; p=0.463).</p> <p> </p> <p><strong>Conclusion:</strong> BNP lost sensibility to predict in-hospital outcome in patients with renal dysfunction and obesity, being less specific in elderly population. Higher values of BNP should be considered in these populations as marker of worst prognosis.</p>
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