NT-proBNP level as a predictor of atrial fibrillation in patients with acute coronary syndrome

V.Y. Tseluyko, F. Ben Salem, O.E. Matuzok


Background. Atrial fibrillation (AF) burdens myocardial infarction in 15.5 % of cases and is associated with 40–50 % mortality increase. The refore, the search for markers of AF risk in patients with acute coronary syndrome (ACS) is a valid task. The aim of present study was to evaluate the predictive value of N-terminal pro B-type natriuretic peptide (NT-proBNP) level regarding the risk of AF in patients with ACS. Materials and methods. We examined 125 patients with ACS. Subgroup 1a consisted of 41 patients with AF newly diagnosed during hospitalization for ACS. Subgroup 1b included 24 patients with history of AF. Patients without AF were included in group 2 (n = 60). Blood samples to determine NT-proBNP level using immunofluorescence assay were taken at admission. Results. Patients in group 2 were younger than those in subgroups 1a (р = 0.019) and 1b (р = 0.002). Persons in group 2 were more likely to be smokers than patients in group 1b (р = 0.029). Patients in group 2 had higher hemoglobin level than those in subgroup 1a (р = 0.014). Patients in subgroup 1b had higher glycemia upon admission compared to those in group 2 (р = 0.010). NT-proBNP level was highest in subgroup 1a: 1592.00 (439.20; 3281.00) pg/ml. In subgroup 1b and group 2, NT-proBNP levels were 1281.00 (844.45; 2012.50) and 226.50 (54.40; 822.00) pg/ml, accordingly (р1а-2 = 0.002; р1b-2 = 0.010). We have found the correlations between
NT-proBNP and the age of examined patients (r = 0.500; р = 0.00006), female sex (r = 0.286; р = 0.030), heart rate and glycemia at admission (r = 0.363; р = 0.005 and r = 0.482; р = 0.0001, accordingly), glomerular filtration rate (r = –0.459; р = 0.0003), hemoglobin level (r = –0.307; р = 0.019). In order to study the predictive value of NT-proBNP level regarding the risk of new-onset AF in ACS patients, we performed ROC analysis. Only patients from subgroup 1a and group 2 were included. At the cut-off point > 1774 pg/ml, the sensitivity was 48 %, the specificity — 95.2 %, area under ROC curve — 0.77 (95% confidence interval 0.64–0.91). Conclusions. In our study, NT-proBNP level depended on clinical and anamnestic parameters. It was highest in patients who developed new-onset AF on the background of ACS. NT-proBNP level > 1774 pg/ml was associated with the risk of AF.


acute coronary syndrome; atrial fibrillation; NT-proBNP


Batra G., Svennblad B., Held C., Jernberg T., Johan-

son P., Wallentin L., Oldgren J. All types of atrial fibrillation in the setting of myocardial infarction are associated with impaired outcome // Heart. — 2016. — Vol. 102. — № 12. — P. 926-933.

Van den Berg N.W.E., de Groot J.R. Myocardial infarction, atrial fibrillation and mortality: timing is everything // Ne-

therlands Heart Journal. — 2015. — Vol. 23. — № 9. — P. 428-429.

Opincariu D., Chițu I.M. Atrial Fibrillation and Acute Myocardial Infarction An Inflammation-Mediated Association // Journal of Cardiovascular Emergencies. — 2018. — Vol. 4. — № 3. — P. 123-132.

Thygesen K., Mair J., Mueller C. et al. Recommendations for the use of natriuretic peptides in acute cardiac care: a position statement from the Study Group on Biomarkers in Cardiology of the ESC Working Group on Acute Cardiac Care // European heart journal. — 2011. — Vol. 33. — № 16. — P. 2001-2006.

Gao X., Zeng R., Liao P., Zhu H., Zhang M. Relation of N-terminal pro-brain natriuretic peptide and new-onset atrial fibrillation in patients with acute coronary syndrome: a systematic review and meta-analysis // Scandinavian journal of clinical and laboratory investigation. — 2016. — Vol. 76. — № 6. — P. 460-464.

Уніфікований клінічний протокол екстреної, первинної, вторинної (спеціалізованої) та третинної (високоспеціалізованої) медичної допомоги «Гострий коронарний синдром з елевацією сегмента ST»: Наказ МОЗ України № 455 від 02.07.2014. URL: 20YKPMD_GKS.pdf.

Уніфікований клінічний протокол екстреної, первинної, вторинної (спеціалізованої) та третинної (високоспеціалізованої) медичної допомоги «Гострий коронарний синдром без елевації сегмента ST»: Наказ МОЗ України № 164 від 03.03.2016. URL: 2016_164_ YKPMD_GKSbezST.pdf

Steg P.G., James S.K., Atar D. et al. Task Force on the ma-nagement of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC) ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation // European heart journal. — 2012. — Vol. 33. — № 20. — P. 2569-2619.

Roffi M., Patrono C., Collet J.P. et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC) // European heart journal. — 2016. — Vol. 37. — № 3. — P. 267-315.

Crenshaw B.S., Ward S.R., Granger C.B., Stebbins A.L., Topol E.J., Califf R.M. Atrial fibrillation in the setting of acute myocardial infarction: the GUSTO-I experience // Journal of the American College of Cardiology. — 1997. — Vol. 30. — № 2. — P. 406-413. DOI: 10.1016/S0735-1097(97)00194-0

Zhang D.Q., Li H. W., Chen H.P., Ma Q., Chen H., Xing Y.L., Zhao X.Q. Combination of amino-terminal Pro-BNP, estimated GFR, and high-sensitivity CRP for predicting cardiorenal syndrome type 1 in acute myocardial infarction patients // Journal of the American Heart Association. — 2018. — Vol. 7. — № 19. — Article ID: e009162.

Puurunen M., Kiviniemi T., Nammas W. et al. Impact of anaemia on clinical outcome in patients with atrial fibrillation undergoing percutaneous coronary intervention: insights from the AFCAS registry // BMJ Оpen. — 2014. — Vol. 4. — № 5. — Article ID: e004700.

Dündar C., Oduncu V., Erkol A. et al. In-hospital prognostic value of hemoglobin levels on admission in patients with acute ST segment elevation myocardial infarction undergoing primary angioplasty // Clinical Research in Cardiology. — 2012. — Vol. 101. — № 1. — P. 37-44.

Martino P., Domenico Z., Alessandro C. et al. Role of plasma glucose level on myocardial perfusion in ST-segment

elevation myocardial infarction patients // Journal of Diabetes and its Complications. — 2018. — Vol. 32. — № 8. — P. 764-769.

Bansal N., Anderson A.H., Yang W. et al. High-sensitivity troponin T and N-terminal pro-B-type natriuretic peptide (NT-proBNP) and risk of incident heart failure in patients with CKD: the Chronic Renal Insufficiency Cohort (CRIC) Study // Journal of the American Society of Nephrology. — 2015. — Vol. 26. — № 4. — P. 946-956.

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