Role of prehospital point-of-care N-terminal pro-brain natriuretic peptide in acute life-threatening cardiovascular disease

Introduction: The evidence about the use of natriuretic peptides (NP) to predict mortality in the pre-hospital setting is limited. The main objective of this study is to assess the ability of point-of-care testing (POCT) N- terminal portion of B-type natriuretic peptide (NT-proBNP) to predict 2-day in-hospital mortality of acute cardiovascular diseases (ACVD). Methods: We conducted a multicentric, prospective, observational study in adults with ACVD transferred by ambulance to emergency departments (ED). The primary outcome was 2-day in-hospital mortality. The discrimination capacity of the NT-proBNP was performed through a prediction model trained using a derivation cohort and evaluated by the area under the curve (AUC) of the receiver operating characteristic on a validation cohort. Results: A total of 1006 patients were recruited. The median age was 75 (IQR 63-84) years and 421 (41.85%) were females. The 2-day in-hospital mortality was 5.8% (58 cases). The predictive validity of NT-proBNP, for 2-day mortality reached the following AUC: 0.823 (95%CI: 0.758-0.889, p < 0.001), and the optimal specificity and sensitivity were 73.1 and 82.7. Predictive power of NT-proBNP obtained an AUC 0.549 (95%CI: 0.432-0.865, p 0.215) for acute heart failure, AUC 0.893 (95%CI: 0.617-0.97, p < 0.001) for ischemic heart disease, AUC 0.714 (95%CI: 0.55-0.87, p = 0.0069) for arrhythmia and AUC 0.927 (95%CI: 0.877-0.978, p < 0,001) for syncope. Conclusion: POCT NT-proBNP has proven to be a strong predictor of early mortality in ACVD, showing an excellent predictive capacity in cases of syncope. However, this biomarker does not appear to be useful for predicting outcome in patients with acute heart failure.