Journal des biomarqueurs moléculaires et du diagnostic

Serial N-Terminal Pro Brain Natriuretic Peptide Assessments in Predicting New-Onset Atrial Fibrillation in ST Elevation Myocardial Infarction Patients who Undergo Primary Percutaneous Coronary Intervention

Abstract

Emel Parlak, Pim Gal, Dirk A.A.M. Schellings, Rypko Beukema, Ahmet Adiyaman, Jurriën ten Berg, Arnoud W.J. van ’t Hof and Arif Elvan

Background: N-terminal pro-Brain Natriuretic Peptide(NT-proBNP)is associated with atrial fibrillation(AF) in the setting of acute ST-elevation myocardial infarction (STEMI), and the present study was aimed at assessing the temporal association between NT-proBNP and incident AF.

Methods: 830 patients enrolled in On-TIME II were included. NT-proBNP was assessed at baseline, 24 h and 72 h after admission for STEMI. Patients with new-onset AF <30 days after STEMI were divided among 3 subgroups: AF on admission, AF 24-72 h after admission and AF >72 h after admission. NT-proBNP serum levels at the three assessment intervals was used to predict the timing of AF with a receiver-operator characteristic, and a binary logistic model was created to predict the AF at the various timings.

Results: Mean age was 62 ±12 years and 76% were male. 73 patients developed incident AF, 41 developed AF on admission, 14 patients developed AF 24-72 h after admission and 18 patients developed AF >72 h after admission. NT-proBNP at baseline (area under curve (AUC) 0.657, P<0.001), after 24 h (AUC 0.829, P<0.001) and after 72 h (AUC 0.891, P<0.001) predicted AF. However, NT-proBNP at baseline did not predict AF on admission (AUC 0.591, P=0.058). NT-proBNP after 24 h and 72 h were stronger predictors of AF compared to NT-proBNP at baseline. In regression analysis, NT-proBNP after 24 h (OR:1.220, P<0.001) and 72 h (OR:1.290, P<0.002) showed a significant association with postinfarction AF.

Conclusion: This study shows serial NT-proBNP plasma level assessments enhance risk stratification for incident AF in STEMI patients.