N-terminal pro-B-type natriuretic peptide and the risk of stroke among patients hospitalized with acute heart failure: an APEX trial substudy.

Abstract

BACKGROUND:

Among patients hospitalized with acute heart failure (HF), the prognostic value of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in short-term stroke prediction remains unclear.

METHODS:

In the APEX trial, 7513 patients hospitalized for an acute medical illness were randomized to receive either extended-duration betrixaban (80 mg once daily for 35-42 days) or standard-of-care enoxaparin (40 mg once daily for 10 ± 4 days) for venous thromboprophylaxis. Baseline NT-proBNP concentrations were obtained in 3261 patients admitted for HF. Stroke events were adjudicated by an independent clinical events committee blinded to thromboprophylaxis allocation. The association of NT-proBNP level and other risk factors and biomarkers with stroke was assessed at 77 days after randomization.

RESULTS:

In univariate analysis, the risk of stroke at 77 days was associated with baseline NT-proBNP (HR 3.63 [95% CI 1.47-8.99]; P = 0.005), D-dimer (HR 2.73 [95% CI 1.03-7.20]; P = 0.043), and hsCRP (HR 3.03 [95% CI 1.36-6.75]; P = 0.007). In multivariable analysis adjusting for hsCRP and thromboprophylaxis, NT-proBNP was associated with the risk of stroke (adjusted HR 3.64 [95% CI 1.35-9.83]; P = 0.011). The interaction of NT-proBNP with the treatment effect was not significant (Pint = 0.30).

CONCLUSIONS:

Baseline NT-proBNP concentration was associated with short-term stroke among patients hospitalized with acute HF. Stroke risk assessment models should consider incorporation of NT-proBNP measurement.

• Authors: Gerald Chi, James L Januzzi, Serge Korjian, Yazan Daaboul, Samuel Z Goldhaber, Adrian F Hernandez, Russell D Hull, Alex Gold, Alexander T Cohen, Robert A Harrington, C Michael Gibson
• Journal: Journal of thrombosis and thrombolysis (J Thromb Thrombolysis) Vol. 44 Issue 4 Pg. 457-465 (Nov 2017) ISSN: 1573-742X [Electronic] Netherlands
• PMID: 28905172 (Publication Type: Journal Article, Randomized Controlled Trial)

Chemical References

• Benzamides
• Enoxaparin
• Peptide Fragments
• Pyridines
• pro-brain natriuretic peptide (1-76)
• Natriuretic Peptide, Brain
• betrixaban

Topics

• Acute Disease
• Aged
• Aged, 80 and over
• Benzamides (administration & dosage)
• Enoxaparin (administration & dosage)
• Female
• Heart Failure (complications, drug therapy)
• Hospitalization
• Humans
• Male
• Natriuretic Peptide, Brain (blood)
• Peptide Fragments (blood)
• Pyridines (administration & dosage)
• Risk Assessment
• Stroke (diagnosis)
• Venous Thrombosis