High NT-proBNP in AMI Linked to Increased Risk for Mortality, Major Adverse CV Events

Mid-adult man clutching his chest in pain with a possible heart attack. He wears a blue, button down dress shirt. Heart disease.
For the first time, researchers conducted a meta-analysis on the association between an elevated NT-proBNP level and an adverse prognosis in patients with AMI.

Patients with acute myocardial infarction (AMI) with elevated N-terminal fragment of the prohormone brain natriuretic peptide (NT-proBNP) were found to be at increased risk for all-cause mortality and major adverse cardiovascular (CV) events. The study findings were published in Heart & Lung.

For the systemic review and meta-analysis, researchers from Tongde Hospital of Zhejiang Provence in China searched publication databases through June 2021 for studies of outcomes from AMI. A total of 19 studies were included in the analysis.

Studies were published between 2003 and 2021 and were conducted in Asia (n=8), Europe (n=6), New Zealand (n=2), North America (n=1), South America (n=1), or multiple locations (n=1).

A total of 12,158 patients with AMI were included, and study sample sizes ranged between 102 and 1621 individuals. The mean follow-up time was 18.5 months.

Increased NT-proBNP levels associated with higher risk for in-hospital or 30-day mortality (risk ratio [RR], 5.28; 95% CI, 2.87-9.73) with no evidence of study heterogeneity (I2, 0.0%; P =.785) among the 4 studies that measured this outcome.

Elevated NT-proBNP was also associated with increased risk for all-cause mortality (RR, 2.62; 95% CI, 2.04-3.37) with no evidence of study heterogeneity (I2, 0.0%; P =.781) among the 9 included studies.

Increased risk for major adverse CV events was observed among 8 studies (RR, 2.50; 95% CI, 1.91-3.28). This comparison included significant study heterogeneity (I2, 59.8%; P =.015). Some of the risk for major adverse CV events decreased after imputing 3 potentially missing studies (RR, 2.09; 95% CI, 1.21-3.43).

In a subgroup analysis, elevated NT-proBNP associated with increased risk for all-cause mortality and major adverse CV events among all tested subgroups of sample size (<500 vs ³500), patients (all AMI vs ST-segment elevation myocardial infarction [all-cause mortality] or non-ST-segment elevation myocardial infarction [major adverse CV events]), percutaneous coronary intervention (all vs intervention), follow-up duration (£12 vs > 12 months), and region (Asia vs not Asia [all-cause mortality]).

This study was limited by the heterogeneity observed for the major adverse CV events comparison.

The study data indicated that patients with AMI and elevated NT-proBNP were at increased risk for poor clinical outcomes of all-cause mortality and major adverse CV events.

“These findings suggest that baseline NT-proBNP level may serve as a promising biomarker in risk classification in patients with AMI,” the researchers said.


Shen S, Ye J, Wu X, Li X. Association of N-terminal pro-brain natriuretic peptide level with adverse outcomes in patients with acute myocardial infarction: A meta-analysis. Heart Lung. Published online August 2, 2021. doi:10.1016/j.hrtlng.2021.07.007