Clinical implication of NT-proBNP to predict mortality in patients with acute type A aortic dissection: a retrospective cohort study

Objectives Acute type A aortic dissection is a life-threatening cardiovascular disease commonly seen in emergency department, resulting in substantial mortality and morbidity. We aimed to investigate the prognostic value of N-terminal pro-B type natriuretic peptide (NT-proBNP) among this critically ill population. Design The design of this study was a retrospective cohort study. Setting The study population was recruited in the Emergency Department of Fuwai hospital in China from 2018 to 2020. Participants We consecutively enrolled 829 patients with acute type A aortic dissection and measurable baseline NT-proBNP. Primary outcome The primary endpoint was 1-year all-cause death. Results Based on tertiles of NT-proBNP (pg/mL), patients were stratified into low (<= 150.3, n=276), intermediate (150.3-667.6, n=277) and high (>667.6, n=276) NT-proBNP groups. Compared with patients with low NT-proBNP, the Kaplan-Meier estimates for primary 1-year mortality were higher in intermediate (32.5% vs 18.1%; HR 1.91, 95% CI 1.35 to 2.69) and high (42.0% vs 18.1%; HR 2.56, 95% CI 1.84 to 3.57) NT-proBNP groups, respectively. After multivariable regression adjusted for confounders, NT-proBNP tertiles were independent predictors for 1-year mortality (adjusted HR for intermediate group 1.52, 95% CI 1.02 to 2.27; adjusted HR for high group 2.17, 95% CI 1.41 to 3.32). Notably, the predictive performance of NT-proBNP for 1-year mortality was greater in patients receiving surgery than conservative treatment (between-cohorts difference in area under the curve 0.13, Delong's test p=0.04). Conclusion NT-proBNP provides incremental prognostic information for mortality in patients with acute type A aortic dissection who underwent surgical repairment, which could aid in risk stratification as a pragmatic and versatile biomarker in this critically ill population while having limited prognostic value for those receiving conservative treatment.