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13.09.2017 | Ausgabe 4/2017

Journal of Thrombosis and Thrombolysis 4/2017

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

Zeitschrift:
Journal of Thrombosis and Thrombolysis > Ausgabe 4/2017
Autoren:
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
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1007/​s11239-017-1552-7) contains supplementary material, which is available to authorized users.
Clinical Trial Registration: Unique identifier: NCT01583218 (URL: http://​www.​clinicaltrials.​gov).

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.

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