Swipe om te navigeren naar een ander artikel
The online version of this article (doi: 10.1007/s12471-016-0935-2) contains supplementary material, which is available to authorized users.
The Zwolle Risk Score (ZRS) identifies primary percutaneous coronary intervention (PPCI) patients at low mortality risk, eligible for early discharge. Recently, this score was improved by adding baseline NT-proBNP. However, the optimal timepoint for NT-proBNP measurement is unknown.
PPCI patients in the On-Time 2 study were candidates. The ZRS and NT-proBNP levels on admission, at 18–24 h, at 72–96 h, and the change in NT-proBNP from baseline to 18–24 h (delta NT-proBNP) were determined. We investigated whether addition of the different NT-proBNP measurements to the ZRS improves the prediction of 30-day mortality. Based on cut-off values reflecting zero mortality at 30 d, patients who potentially could be discharged early were identified and occurrence of major adverse cardiac events (MACE) and major bleeding until 10 d was registered.
845 patients were included. On multivariate analyses, NT-proBNP at baseline (HR 2.09, 95% CI 1.59–2.74, p < 0.001), at 18–24 h (HR 6.83, 95% CI 2.94–15.84), and at 72–96 h (HR 3.32, 95% CI 1.22–9.06) independently predicted death at 30 d. Addition of NT-proBNP to the ZRS improved prediction of mortality, particularly at 18–24 h (net reclassification index 29%, p < 0.0001, integrated discrimination improvement 17%, p < 0.0001). Based on ZRS (<2) or NT-proBNP at 18–24 h (<2500 pg/ml) 75% of patients could be targeted for early discharge at 48 h, with expected re-admission rates of 1.2% due to MACE and/or major bleeding.
NT-proBNP at different timepoints improves prognostication of the ZRS. Particularly at 18–24 h post PPCI, the largest group of patients that potentially could be discharged early was identified.
Supplementary Fig. 3 Outcome of all patients screened by the decision rules. Percentages (%) are given with reference to the study population (n = 845). Multiple events could occur in one patient12471_2016_935_MOESM1_ESM.tif
Supplementary Table 4 Predictive accuracy of ZRS < 2 and NT-proBNP with cut-off values at different timepoints for the identification of PPCI patients eligible for early discharge12471_2016_935_MOESM2_ESM.docx
Steg PG, James SK, Atar D, et al. The Task Force on the management of ST-segment elevation myocardial infarction of the European Society of Cardiology (ESC). ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J. 2012;33:2569–619, www.escardio.org/guidelines. CrossRefPubMed
O’Gara PT, Kushner FG, Ascheim DD, et al. American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. 2013 ACCF/AHA Guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/ American Heart Association Task Force on Practice Guidelines. Circulation. 2013;127:e362–e425. CrossRefPubMed
Grines CL, Marsalese DL, Brodie B, et al. Safety and cost-effectiveness of early discharge after primary angioplasty in low risk patients with acute myocardial infarction. PAMI-II investigators. Primary angioplasty in myocardial infarction. J Am Coll Cardiol. 1998;5:967–72. CrossRef
Branca G, Capodanno D, Capranzano P, et al. Early discharge in acute myocardial infarction after clinical and angiographic risk assessment. J Cardiovasc Med (Hagerstown). 2008;9:858–61. CrossRef
Kotowycz MA, Cosman TL, Tartaglia C, et al. Safety and feasibility of early hospital discharge in ST-segment elevation myocardial infarction – a prospective and randomized trial in low risk primary percutaneous coronary intervention patients (The Safe-Depart Trial). Am Heart J. 2010;159:117.e1–117.e6. CrossRef
Van’t Hof AWJ, ten Berg JM, Heestermans T, et al. Ongoing tirofiban in myocardial infarction evaluation (On-Time) 2 study group. Prehospital initiation of tirofiban in patients with ST-elevation myocardial infarction undergoing primary angioplasty (On-TIME 2): a multicentre, double blind, randomised controlled trial. Lancet. 2008;372:537–46. CrossRefPubMed
On behalf of the On-TIME 2 investigators, Van’t Hof AWJ, Hamm C, Rasoul S, et al. Ongoing tirofiban in myocardial infarction evaluation (On-TIME) 2 trial: rationale and study design. EuroIntervention. 2007;3:371–80. CrossRef
Rubin DB. Multiple imputation for nonresponse in surveys. New York: J. Wiley & Sons; 1987. CrossRef
AMI-Florence Working Group, Barchielli A, Balzi D, Marchionni N, et al. Early discharge after acute myocardial infarction in the current clinical practice. Community data from the AMI-Florence Registry, Italy. Int J Cardiol. 2007;114:57–63. CrossRef
Claeys MJ, Sinnaeve PR, Convens C, et al. Inter-hospital variation in length of hospital stay after ST-elevation myocardial infarction: results from the Belgian STEMI registry. Acta Cardiol. 2013;68:235–9. PubMed
Jarai R, Huber K, Bogaerts K, et al. ASSENT-IV-PCI investigators. Plasma N‑terminal fragment of the prohormone B‑type natriuretic peptide concentrations in relation to time to treatment and thrombolysis in myocardial infarction (TIMI) flow: a substudy of the assessment of the safety and efficacy of a new treatment strategy with percutaneous coronary intervention (ASSENT IV-PCI) trial. Am Heart J. 2010;159:131–40. CrossRefPubMed
Korea Acute Myocardial Infarction Registry Investigators, Kwon TG, Bae JH, Jeong MH, et al. N‑terminal pro-B-type natriuretic peptide is associated with adverse short-term clinical outcomes in patients with acute ST-elevation myocardial infarction who underwent primary percutaneous coronary intervention. Int J Cardiol. 2009;133:173–8. CrossRef
- NT-proBNP during and after primary PCI for improved scheduling of early hospital discharge
D. A. A. M. Schellings
A. W. J. van ’t Hof
J. M. ten Berg
- Bohn Stafleu van Loghum