Prognostic value of N-terminal pro-B-type natriuretic peptide and C reactive protein testing in patients with acute ST-segment elevation myocardial infarction

Open Heart. 2026 Jan 16;13(1):e003845. doi: 10.1136/openhrt-2025-003845.

Abstract

Background: Biomarkers could improve risk stratification in patients with acute ST-segment elevation myocardial infarction (STEMI), beyond left ventricular ejection fraction (LVEF). Our study evaluated the association between N-terminal pro-B-type natriuretic peptide (NT-proBNP), C reactive protein (CRP) and mortality in a cohort of patients with acute STEMI.

Methods: This prospective, observational cohort study included patients with reperfused acute STEMI admitted to a tertiary cardiovascular disease centre between July 2020 and October 2023. All patients underwent NT-proBNP and CRP testing. The association between NT-proBNP, CRP and all-cause mortality was evaluated in relation to predischarge LVEF.

Results: The cohort included 566 patients with a mean age of 63 years. After a median follow-up of 39 months, postdischarge all-cause mortality reached 13.4%. NT-proBNP was associated with mortality irrespective of LVEF (HR 2.34 per SD increment in log NT-proBNP; p<0.001 at LVEF <50% and HR 2.36; p=0.004 at LVEF ≥50%), but the association between CRP and mortality was significant only in patients with LVEF <50% (HR 1.55, p=0.003). Across the cohort, NT-proBNP remained associated with death after adjustment for age, sex, diabetes, baseline high-sensitivity cardiac troponin T (hs-cTnT), CRP, final Thrombolysis in myocardial infarction (TIMI) flow grade and reduced LVEF (HR 1.45, p=0.03). In patients with preserved LVEF, routine NT-proBNP testing (area under the curve (AUC) 0.753 (0.642-0.863), p<0.001) improved risk stratification compared with isolated LVEF assessment (AUC 0.592 (0.453-0.730), p=0.18).

Conclusions: In a cohort of stabilised acute STEMI survivors, NT-proBNP was associated with all-cause mid-term mortality independent of hs-cTnT and LVEF. The association between CRP and mortality was significant only in patients with LVEF <50%.

Keywords: Biomarkers; Inflammation; Myocardial Infarction.

Publication types

  • Observational Study

MeSH terms

  • Aged
  • Biomarkers / blood
  • C-Reactive Protein* / analysis
  • C-Reactive Protein* / metabolism
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Natriuretic Peptide, Brain* / blood
  • Peptide Fragments* / blood
  • Predictive Value of Tests
  • Prognosis
  • Prospective Studies
  • Risk Assessment / methods
  • Risk Factors
  • ST Elevation Myocardial Infarction* / blood
  • ST Elevation Myocardial Infarction* / diagnosis
  • ST Elevation Myocardial Infarction* / mortality
  • ST Elevation Myocardial Infarction* / physiopathology
  • Stroke Volume / physiology
  • Ventricular Function, Left* / physiology

Substances

  • Natriuretic Peptide, Brain
  • Peptide Fragments
  • pro-brain natriuretic peptide (1-76)
  • Biomarkers
  • C-Reactive Protein