{"doi":"10.1161/circheartfailure.122.010259","title":"Prognostic Importance of NT-proBNP (N-Terminal Pro-B-Type Natriuretic Peptide) Following High-Risk Myocardial Infarction in the PARADISE-MI Trial","abstract":"Background: NT-proBNP (N-terminal pro-B-type natriuretic peptide) is a potent predictor of death and heart failure (HF) across multiple populations. We evaluated the prognostic importance of NT-proBNP in patients with acute myocardial infarction (MI) complicated by left ventricular systolic dysfunction, pulmonary congestion, or both and ≥1 of 8 risk-augmenting factors enrolled in the PARADISE-MI trial (Prospective ARNI vs ACE Inhibitor Trial to Determine Superiority in Reducing Heart Failure Events After Myocardial Infarction). Methods: Patients were randomized to sacubitril/valsartan 200 mg or ramipril 5 mg twice daily within 0.5 to 7 days of a MI. Patients with prior HF were excluded. NT-proBNP and hs-cTnT (high-sensitivity troponin T) were collected at randomization in a prespecified substudy of 1129 patients. The primary end point of PARADISE-MI was a composite of cardiovascular death or incident HF (hospitalization or outpatient symptomatic HF), analyzed as time-to-first event; additional end points included all-cause death and the composite of fatal or nonfatal MI or stroke. Results: Median NT-proBNP was 1757 ng/L (25th–75th percentiles, 896–3462 ng/L) at randomization (4.0±1.8 days after the index MI). Patients in the highest quartile of NT-proBNP were older, more commonly women and had more hypertension, atrial fibrillation, renal dysfunction, and pulmonary congestion on presentation (all P <0.001). NT-proBNP was strongly associated with the primary end point (adjusted hazard ratio, 1.45 per doubling of NT-proBNP; [95% CI, 1.23–1.70]), adjusted for clinical variables and baseline hs-cTnT. NT-proBNP was also independently associated with all-cause death (adjusted hazard ratio, 1.74 [95% CI, 1.38–2.21]) and fatal or nonfatal MI or stroke (adjusted hazard ratio, 1.24 [95% CI, 1.05–1.45]). NT-proBNP did not significantly modify the neutral treatment effect of sacubitril/valsartan relative to ramipril ( P interaction=0.46). Conclusions: Within the first week of a high-risk MI NT-proBNP is associated with incident HF, death and atherosclerotic events. This prognostic information is independent of hs-cTnT. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02924727.","journal":"Circulation Heart Failure","year":2023,"id":319904,"datarank":1.2547206952340721,"base_score":3.970291913552122,"endowment":3.970291913552122,"self_citation_contribution":0.5955437870328184,"citation_network_contribution":0.6591769082012537,"self_endowment_contribution":0.5955437870328184,"citer_contribution":0.6591769082012537,"corpus_percentile":null,"corpus_rank":null,"citation_count":52,"citer_count":42,"citers_with_citation_signal":23,"citers_with_endowment":23,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9659,"is_data_producer":true,"deposit_databanks":{"ClinicalTrials.gov":["NCT02924727"]},"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":28286,"name":"Brian Claggett","orcid":"0000-0002-4215-9218","position":1,"is_corresponding":false},{"id":39751,"name":"Marc A. Pfeffer","orcid":"0000-0003-3876-7568","position":2,"is_corresponding":false},{"id":260564,"name":"Christopher B. Granger","orcid":"0000-0002-0045-3291","position":3,"is_corresponding":false},{"id":2621,"name":"Lars Køber","orcid":"0000-0002-6635-1466","position":4,"is_corresponding":false},{"id":290057,"name":"Eldrin F. Lewis","orcid":null,"position":5,"is_corresponding":false},{"id":2622,"name":"Aldo P. Maggioni","orcid":"0000-0003-2764-6779","position":6,"is_corresponding":false},{"id":233712,"name":"Douglas L. Mann","orcid":"0000-0002-2516-0145","position":7,"is_corresponding":false},{"id":2612,"name":"John J.V. McMurray","orcid":"0000-0002-6317-3975","position":8,"is_corresponding":false},{"id":273235,"name":"Margaret F. Prescott","orcid":null,"position":9,"is_corresponding":false},{"id":277561,"name":"Jean L. Rouleau","orcid":"0000-0002-5353-3877","position":10,"is_corresponding":false},{"id":27970,"name":"Scott D. Solomon","orcid":"0000-0003-3698-9597","position":11,"is_corresponding":false},{"id":79684,"name":"Philippe Gabríel Steg","orcid":"0000-0001-6896-2941","position":12,"is_corresponding":false},{"id":274036,"name":"Dirk von Lewinski","orcid":"0000-0001-9996-6128","position":13,"is_corresponding":false},{"id":2019,"name":"Eugene Braunwald","orcid":"0000-0002-3472-626X","position":14,"is_corresponding":false},{"id":260469,"name":"Karola Jering","orcid":"0000-0002-5243-1959","position":0,"is_corresponding":true}],"reference_count":43,"raw_metadata":null,"created_at":"2026-07-19T01:07:17.361058Z","pmid":"37125529","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}