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09-12-2016 | Original Article - Design Study Article | Uitgave 4/2017 Open Access

Netherlands Heart Journal 4/2017

NT-proBNP during and after primary PCI for improved scheduling of early hospital discharge

Tijdschrift:
Netherlands Heart Journal > Uitgave 4/2017
Auteurs:
D. A. A. M. Schellings, A. W. J. van ’t Hof, J. M. ten Berg, A. Elvan, E. Giannitsis, C. Hamm, H. Suryapranata, A. Adiyaman
Belangrijke opmerkingen

Electronic supplementary material

The online version of this article (doi: 10.​1007/​s12471-016-0935-2) contains supplementary material, which is available to authorized users.

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

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Netherlands Heart Journal

Het Netherlands Heart Journal wordt uitgegeven in samenwerking met de Nederlandse Vereniging voor Cardiologie en de Nederlandse Hartstichting. Het tijdschrift is Engelstalig en wordt gratis beschikbaa ...

Extra materiaal
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 patient
12471_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 discharge
12471_2016_935_MOESM2_ESM.docx
Literatuur
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