Marijn J Holl1, Ewout J van den Bos2, Ron T van Domburg1, Michael A Fouraux3, Marcel J Kofflard2. 1. Department of Cardiology, The Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands. 2. Department of Cardiology, Albert Schweitzer Hospital, Dordrecht, The Netherlands. 3. Department of Clinical Chemistry, Albert Schweitzer Hospital, Dordrecht, The Netherlands.
Abstract
BACKGROUND: Atrial fibrillation (AF) is the most common cardiac arrhythmia in the emergency department. The CHA2 DS2 -VASc score helps to predict thromboembolic risk; however, the rate of other adverse cardiac events is more difficult to predict. HYPOTHESIS: The biomarker N-terminal pro-brain natriuretic peptide (NT-proBNP) has prognostic value in patients presenting to the emergency department with AF. METHODS: During a 1.5-year period, a prospective study was performed in consecutive patients presenting to the emergency department with AF on the presenting electrocardiogram. At baseline, NT-proBNP was measured. The primary endpoints were all-cause death and major adverse cardiac events (MACE: all-cause mortality, myocardial infarction, or revascularization). RESULTS: A total of 355 patients were included (mean age, 71 years; 55% male). The median duration of follow-up was 2 years. After adjustment for baseline variables, the logNT-proBNP was independently correlated with death (hazard ratio [HR]: 1.54, 95% confidence interval [CI]: 1.18-1.99) and MACE (HR: 1.27, 95% CI: 1.03-1.58). After adjustment for baseline variables, a high NT-proBNP value (>500 pmol/L) was independently correlated with death (HR: 2.26, 95% CI: 1.19-4.28), and for MACE a trend was seen (HR: 1.67, 95% CI: 0.96-2.91) compared with a low value (<250 pmol/L). CONCLUSIONS: In patients presenting to the emergency department with AF, higher NT-proBNP values are independently associated with an increased mortality and MACE. Therefore, this biomarker may be a useful prognostic marker in the management and treatment of these patients.
BACKGROUND:Atrial fibrillation (AF) is the most common cardiac arrhythmia in the emergency department. The CHA2 DS2 -VASc score helps to predict thromboembolic risk; however, the rate of other adverse cardiac events is more difficult to predict. HYPOTHESIS: The biomarker N-terminal pro-brain natriuretic peptide (NT-proBNP) has prognostic value in patients presenting to the emergency department with AF. METHODS: During a 1.5-year period, a prospective study was performed in consecutive patients presenting to the emergency department with AF on the presenting electrocardiogram. At baseline, NT-proBNP was measured. The primary endpoints were all-cause death and major adverse cardiac events (MACE: all-cause mortality, myocardial infarction, or revascularization). RESULTS: A total of 355 patients were included (mean age, 71 years; 55% male). The median duration of follow-up was 2 years. After adjustment for baseline variables, the logNT-proBNP was independently correlated with death (hazard ratio [HR]: 1.54, 95% confidence interval [CI]: 1.18-1.99) and MACE (HR: 1.27, 95% CI: 1.03-1.58). After adjustment for baseline variables, a high NT-proBNP value (>500 pmol/L) was independently correlated with death (HR: 2.26, 95% CI: 1.19-4.28), and for MACE a trend was seen (HR: 1.67, 95% CI: 0.96-2.91) compared with a low value (<250 pmol/L). CONCLUSIONS: In patients presenting to the emergency department with AF, higher NT-proBNP values are independently associated with an increased mortality and MACE. Therefore, this biomarker may be a useful prognostic marker in the management and treatment of these patients.
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