NT-proBNP is associated with mortality and adverse cardiac events in patients with atrial fibrillation presenting to the emergency department

Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia in the emergency department. The CHA2DS2-VASc score helps to predict thromboembolic risk; however, the rate of other adverse cardiac events is more difficult to predict. Hypothesis: The biomarker N-terminal pro-brain natriuretic peptide (NT-proBNP) has prognostic value in patients presenting to the emergency department with AF. Methods: During a 1.5-year period, a prospective study was performed in consecutive patients presenting to the emergency department with AF on the presenting electrocardiogram. At baseline, NT-proBNP was measured. The primary endpoints were all-cause death and major adverse cardiac events (MACE: all-cause mortality, myocardial infarction, or revascularization). Results: A total of 355 patients were included (mean age, 71years; 55% male). The median duration of follow-up was 2years. After adjustment for baseline variables, the logNT-proBNP was independently correlated with death (hazard ratio [HR]: 1.54, 95% confidence interval [CI]: 1.18-1.99) and MACE (HR: 1.27, 95% CI: 1.03-1.58). After adjustment for baseline variables, a high NT-proBNP value (>500pmol/L) was independently correlated with death (HR: 2.26, 95% CI: 1.19-4.28), and for MACE a trend was seen (HR: 1.67, 95% CI: 0.96-2.91) compared with a low value (<250pmol/L). Conclusions: In patients presenting to the emergency department with AF, higher NT-proBNP values are independently associated with an increased mortality and MACE. Therefore, this biomarker may be a useful prognostic marker in the management and treatment of these patients.

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