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NT-proBNP for Risk Assessment in Patients with Atrial Fibrillation: Insights from the ARISTOTLE trial.

著者 Hijazi Z , Wallentin L , Siegbahn A , Andersson U , Christersson C , Ezekowitz J , Gersh BJ , Hanna M , Hohnloser S , Horowitz J , Huber K , Hylek EM , Lopes RD , McMurray JJ , Granger CB
J Am Coll Cardiol.2013 Apr 3 ; ():.
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Uppsala Clinical Research Center (UCR), Uppsala University, Uppsala, Sweden; Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden. Electronic address: Ziad.Hijazi@ucr.uu.se.

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OBJECTIVE: To assess the prognostic value of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in patients with atrial fibrillation (AF) enrolled in the ARISTOTLE trial, and the treatment effect of apixaban according to NT-proBNP levels. BACKGROUND: Natriuretic peptides are associated with mortality and cardiovascular events in several cardiac diseases. METHODS: In the ARISTOTLE trial, 18,201 patients with AF were randomized to apixaban or warfarin. Plasma samples at randomization were available from 14,892 patients. The association between NT-proBNP concentrations and clinical outcomes was evaluated using Cox proportional hazard models, after adjusting for established cardiovascular risk factors. RESULTS: Quartiles of NT-proBNP were Q1:≤363, Q2:364-713, Q3:714-1250 and Q4:>1250 ng/L. During 1.8 years the annual rates of stroke or systemic embolism ranged from 0.74% in the bottom NT-proBNP quartile to 2.21% in the top quartile, adjusted hazard ratio (HR) 2.35 (95% CI 1.62-3.40, p<0.0001. Annual rates of cardiac death ranged from 0.86% in Q1 to 4.14% in Q4, adjusted HR 2.50 (1.81-3.45), p<0.0001. Adding NT-proBNP levels to the CHA2DS2VASc score improved C-statistics from 0.62 to 0.65 (p=0.0009) for stroke or systemic embolism and from 0.59 to 0.69 for cardiac death (p<0.0001). Apixaban reduced stroke, mortality, and bleeding regardless of the NT-proBNP level. CONCLUSIONS: Levels of NT-proBNP are often elevated in AF and independently associated with an increased risk for stroke and mortality. NT-proBNP improves risk stratification beyond the CHA2DS2VASc score and might be a novel tool for improved stroke prediction in AF. The efficacy of apixaban compared to warfarin is independent of the NT-proBNP level.
PMID: 23563134 [PubMed - as supplied by publisher]
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