NTproBNP and clinical predictors of incident atrial fibrillation in ST elevation myocardial infarction patients undergoing primary percutaneous coronary intervention

Purpose: We aimed to investigate if baseline NTproBNP and clinical variables, predict incident atrial fibrillation (AF) in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PPCI). Methods: From a prospective registry, we assessed 984 PPCI patients. In univariate and multivariate regression analysis, we investigated the association of NTproBNP level determined just prior to PPCI, peri-procedural systolic and diastolic blood pressure, infarct size (maximum CK), gender and age, with the incidence of AF. A Kaplan-Meier curve with quartiles of NTproBNP was computed with a log-rank test to assess for significance of differences. Results: NTproBNP was higher (1297 pg/ml versus 570 pg/ml) in patients with versus without incident AF. In univariate analysis, NTproBNP was significantly associated with incident AF (OR 1,11, 95% CI 1,03-1,21, P=0,009). In multivariate analysis, age was the strongest predictor of incident AF (highest quartiles versus lowest quartile OR 7,04, 95% CI 2,77 -17,87, P<0,001). NTproBNP (OR 1,09, 95% CI 1,00 -1,20, P=0,049), systolic blood pressure (OR 0,98, 95% CI 0,97 -1,00, P=0,021) and infarct size (OR 1,18, 95% CI 1,04 -1,33, P=0,01) were also independently associated with incident AF. Gender, target lesion vessel and diastolic blood pressure were not associated with incident AF. Kaplan-Meier curves (Figure 1) depict that higher NTproBNP quartile is significantly (P=0,001) associated with incident AF. Figure 1. Kaplan-Meier curves Conclusion: Age is strongly predictive for incident AF in STEMI patients undergoing PPCI. NTproBNP and infarct size are also independent predictors of incident AF, whereas peri-procedural systolic blood pressure is inversely related to incident AF.