P4316N-terminal pro-B-type natriuretic peptide (NT-proBNP) is associated with stroke among hospitalized medical patients: an APEX trial substudy

Abstract

Background: Stroke risk stratification targeting hospitalized medical patients remains a challenge. Purpose: The study aimed to assess the predictive value of N‐terminal pro‐B‐ type natriuretic peptide (NT‐proBNP) for stroke and its impact on the treatment effect of betrixaban. Methods: In the APEX trial, 7,513 hospitalized medical patients were randomized to receive betrixaban (80 mg od for 35‐42 days) or enoxaparin (40 mg od for 10±4 days) for VTE prevention. NT‐proBNP was analyzed by the central laboratory at baseline. The association of NT‐proBNP levels and other risk factors with stroke was assessed at 77 days after randomization. The rate of stroke was compared between treatment groups stratified by NT‐proBNP. Results: Baseline NT‐proBNP was measured in 4,542 hospitalized patients (median: 1,525 ng/L; IQR: 429‐4,759 ng/L). NT‐proBNP was both a univariate and a multivariate correlate of stroke (Table). Compared to enoxaparin, betrixaban was associated with a significant stroke reduction among patients with elevated NT‐proBNP (0.69% vs 2.09%; RR=0.33 [95% CI: 0.13‐0.83]; P=0.013; NNT=72). There was an absolute risk difference of 1.40% using 2,750 ng/L as the cutoff, a cutoff that was independently associated with stroke at 77 days (adjusted OR=3.51 [95% CI: 1.63‐7.54]; P=0.0013). Conclusions: NT‐proBNP is an independent correlate of 77‐day stroke among hospitalized medical patients. Strategies to improve stroke risk stratification should consider incorporation of NT‐proBNP measurement into standard risk assessment models. (Figure Presented).