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Association between BNP levels and new-onset atrial fibrillation

A propensity score approach

Zusammenhang zwischen BNP-Werten und neu aufgetretenem Vorhofflimmern

Ein Propensity-Score-Ansatz

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Abstract

Background

New-onset atrial fibrillation (NOAF), a common complication of acute ST-segment elevation myocardial infarction (STEMI), is associated with a poor prognosis. Several clinical and laboratory parameters are reported to be associated with NOAF in patients with STEMI. The aim of the present study was to evaluate the predictive value of plasma B‑type natriuretic peptide (BNP) levels for NOAF development and long-term prognosis in STEMI patients undergoing primary percutaneous coronary intervention (pPCI).

Patients and methods

We retrospectively enrolled 1,928 patients with STEMI who underwent pPCI. After applying exclusion criteria, 1,057 patients were retained in the final study population. Patients with NOAF were compared with patients without NOAF in the entire study population and in a matched group.

Results

Patients with NOAF had a significantly higher average plasma BNP level (161 pg/ml, range: 72.3–432) than patients without NOAF in the study population (70.7 pg/ml, range: 70–129; p < 0.001) and in the matched group (104.6 pg/ml, range: 47.2–234.5; p = 0.014). Furthermore, the plasma BNP level was found to be an independent predictor of NOAF development (odds ratio [OR]: 1.003; 95% confidence interval [CI]: 1.000–1.005; p = 0.034) and mortality in the long-term follow-up (OR: 1.004; 95% CI: 1.002–1.006; p < 0.001).

Conclusion

The present study found that a high plasma BNP level was significantly associated with NOAF development in STEMI patients, and was an independent predictor of NOAF development and all-cause mortality during long-term follow-up, regardless of other NOAF risk factors.

Zusammenfassung

Hintergrund

Neu aufgetretenes Vorhofflimmern („new-onset atrial fibrillation“, NOAF), eine häufige Komplikation des akuten ST-Strecken-Hebungs-Infarkts (STEMI), geht mit einer schlechten Prognose einher. Verschiedene klinische und Laborparameter sollen mit NOAF bei STEMI-Patienten in Zusammenhang stehen. Ziel der vorliegenden Studie war es, den prädiktiven Wert der Werte für BNP („B-type natriuretic peptide“) für das Auftreten von NOAF und die Langzeitprognose bei STEMI-Patienten nach primärer perkutaner Koronarintervention (pPCI) zu untersuchen.

Patienten und Methoden

Retrospektiv wurden 1928 Patienten mit STEMI und nach pPCI in die Studie aufgenommen. Nach Anwendung der Ausschlusskriterien verblieben letztlich 1057 Patienten in der Studienpopulation. Dabei wurden in der gesamten Studienpopulation und einer entsprechend ausgewählten Gruppe Patienten mit NOAF im Vergleich zu Patienten ohne NOAF betrachtet.

Ergebnisse

Die Patienten mit NOAF wiesen einen signifikant höheren durchschnittlichen Plasma-BNP-Wert auf (161 pg/ml, Spannbreite: 72,3–432) als Patienten ohne NOAF in der Studienpopulation (70,7 pg/ml, Spannbreite: 70–129; p < 0,001) und in der gematchten Gruppe (104,6 pg/ml, Spannbreite: 47,2–234,5; p = 0,014). Darüber hinaus stellte sich der Plasma-BNP-Wert als ein unabhängiger Prädiktor des Auftretens von NOAF (Odds Ratio, OR: 1,003; 95%-Konfidenzintervall, 95%-KI: 1,000–1,005; p = 0,034) und der Mortalität während der Langzeitnachbeobachtung heraus (OR: 1,004; 95%-KI: 1,002–1,006; p < 0,001).

Schlussfolgerung

In der vorliegenden Studie wurde festgestellt, dass ein hoher Plasma-BNP-Wert in signifikanter Weise mit dem Auftreten von NOAF bei STEMI-Patienten in Zusammenhang steht und sich als unabhängiger Prädiktor des Auftretens von NOAF und der Gesamtmortalität während der Langzeitnachbeobachtung, unabhängig von Risikofaktoren für NOAF, herausstellte.

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Authors and Affiliations

  1. Department of Cardiology, Kafkas University Medical Faculty, Kars, Turkey

    Y. Karabağ,  I. Rencuzogullari, M. Çağdaş, S. Karakoyun, İnanç Artaç & Doğan İliş

  2. Department of Cardiology, Kars Harakani State Hospital, Kars, Turkey

    M. Yesin

  3. Department of Cardiology, Yedikule Chest Diseases and Chest Surgery Education and Research Center, Istanbul, Turkey

    M. Uluganyan

  4. Department of Cardiology, Gaziemir State Hospital, İzmir, Turkey

    M. O. Gürsoy

  5. Department of Cardiology, Medipol University Medical Faculty, İstanbul, Turkey

    Tayyar Gökdeniz

  6. Department of Cardiology, Ağrı State Hospital, Ağrı, Turkey

    S. Ç. Efe

  7. Department of Cardiology, Elazığ Education and Research Hospital, Elazığ, Turkey

    O. Taşar

  8. Department of Cardiology, Ataturk University Medical Faculty, Erzurum, Turkey

    H. İ. Tanboğa

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  1. Y. Karabağ
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Corresponding author

Correspondence to I. Rencuzogullari.

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Conflict of interest

Y. Karabağ, I. Rencuzogullari, M. Çağdaş, S. Karakoyun, M. Yesin, M. Uluganyan, M.O. Gürsoy, İ. Artaç, D. İliş, T. Gokdeniz, S.Ç. Efe, O. Taşar, and H.İ. Tanboğa declare that they have no competing interests.

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

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Karabağ, Y., Rencuzogullari, I., Çağdaş, M. et al. Association between BNP levels and new-onset atrial fibrillation. Herz 43, 548–554 (2018). https://doi.org/10.1007/s00059-017-4598-6

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  • DOI: https://doi.org/10.1007/s00059-017-4598-6

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