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NT-proBNP in patients presenting with myocardial infarction and non-obstructive coronary arteries without left
Robert Sykes1,2, Daniel Doherty2, Andrew Morrow1,2
1School of Cardiovascular and Metabolic Health, University of Glasgow, G12 8TA, UK.
Insights
Myocardial infarction with non-obstructive coronary arteries (MINOCA) lacks treatment. NT-proBNP levels ≥125 pg/mL in MINOCA patients with preserved ejection fraction predict rehospitalization, offering a potential prognostic marker.
Area of Science:
- Cardiology
- Biomarkers
- Acute Coronary Syndromes
Background:
- Myocardial infarction with non-obstructive coronary arteries (MINOCA) affects a significant portion of acute coronary syndrome patients.
- Currently, no evidence-based therapy exists for MINOCA.
- NT-proBNP is a known prognostic biomarker in heart failure and ischemic heart disease, but its utility in MINOCA is understudied.
Purpose of the Study:
- To investigate the diagnostic and clinical utility of NT-proBNP measurement in MINOCA patients.
- To assess the association of NT-proBNP levels with clinical outcomes in MINOCA without left ventricular dysfunction or heart failure.
Main Methods:
- Prospective study involving patients diagnosed with MINOCA post-coronary angiography.
- Collection of demographic data, left ventricular function via echocardiography, and NT-proBNP levels from blood samples.
- Prospective follow-up of patient outcomes, including hospital readmissions and mortality.
Main Results:
- Fifty-five MINOCA patients with ejection fraction >40% were included; NT-proBNP was available in 87%.
- A median NT-proBNP of 312 pg/mL was observed.
- 40% of patients were readmitted post-discharge, with NT-proBNP ≥125 pg/mL significantly associated with rehospitalization (P=0.02).
Conclusions:
- NT-proBNP ≥125 pg/mL was identified in 72% of MINOCA patients with preserved ejection fraction.
- Elevated NT-proBNP levels are associated with an increased risk of rehospitalization in this population.
Background:
Myocardial infarction and non-obstructive coronary arteries (MINOCA) affects 1 in 9 patients with acute coronary syndrome and has no evidence-based therapy. NT-proBNP is an established biomarker associated with prognosis in heart failure and ischemic heart disease, although there is a paucity of data in patients with MINOCA.
Methods:
Prospective study of the diagnostic and clinical utility of measuring NT-proBNP in patients with MINOCA without left ventricular dysfunction or heart failure. Data collection was undertaken for patients with an initial diagnosis of MINOCA following urgent coronary angiography in the Golden Jubilee National Hospital (Clydebank, UK), a tertiary center. Demographics were collected in addition to left ventricular function by transthoracic echocardiography. NT-proBNP was measured from a clinically indicated blood sample obtained during routine venepuncture or within the catheter laboratory. Patient outcomes were collected prospectively by the clinical care team using digital follow-up.
Results:
Fifty-five patients with an initial diagnosis of MINOCA and left ventricular ejection fraction >40 % were included. NT-proBNP was available in 87 % of patients with a median value of 312 pg/mL (interquartile range: 107, 725). Post-discharge, 40 % (n = 24) of patients were readmitted to the hospital, including 15 with chest pain. NT-proBNP ≥125 pg/mL was associated with rehospitalization (P = 0.02). Two patients died and bleeding complications with concomitant antiplatelet therapy occurred in eight patients.
Conclusion:
NT-proBNP ≥ 125 pg/mL occurred in 72 % of patients presenting with MINOCA and an ejection fraction > 40% and was associated with rehospitalization.
