N‐terminal pro‐B‐type natriuretic peptide improves the predictive value of CHA(2)DS(2)‐VASc risk score for long‐term cardiovascular events in acute coronary syndrome patients with atrial fibrillation

BACKGROUND: It is important to identify patients with co‐morbid acute coronary syndrome (ACS) and atrial fibrillation (AF) at high risk and adopt proper management strategies to improve their prognosis. HYPOTHESIS: The addition of N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) could improve predictive value for long‐term cardiovascular events beyond the CHA(2)DS(2)‐VASc score in patients with co‐morbid ACS and AF. METHODS: A total of 1223 patients with baseline NT‐proBNP between January 2016 and December 2019 were included in the study. The primary endpoint was all‐cause death at 12 months. The secondary outcomes included 12‐month cardiac death and major adverse cardiovascular and cerebrovascular event (MACCE), defined as a composite of all‐cause death, myocardial infarction, or stroke. RESULTS: A higher serum of NT‐proBNP levels was strongly associated with increased risks of all‐cause death (adjusted hazard ratio [HR]: 1.05, 95% confidence interval [CI], 1.03–1.07), cardiac death (adjusted HR: 1.05, 95% CI, 1.03–1.07), and MACCE (adjusted HR: 1.04, 95% CI, 1.02–1.06). The prognostic accuracy of the CHA(2)DS(2)‐VASc score was improved when combined with NT‐proBNP to yield a 9%, 11%, and 7% increment for the discrimination of long‐term risk for all‐cause mortality (area under curve [AUC]: from 0.64 to 0.73), cardiac death (AUC: from 0.65 to 0.76), and MACCE (AUC: from 0.62 to 0.69), respectively. CONCLUSIONS: In patients with ACS and AF, NT‐proBNP is a potential biomarker to enhance risk discrimination for all‐cause death, cardiac death, and MACCE in combination with the CHA(2)DS(2)‐VASc score.