NT-proBNP (N-Terminal pro-B-Type Natriuretic Peptide)-Guided Therapy in Acute Decompensated Heart Failure PRIMA II Randomized Controlled Trial (Can NT-ProBNP-Guided Therapy During Hospital Admission for Acute Decompensated Heart Failure Reduce Mortality and Readmissions?)
Por:
Stienen, S, Salah, K, Moons, AH, Bakx, AL, van Pol, P, Kortz, RAM, Ferreira, JP, Marques, I, Schroeder-Tanka, JM, Keijer, JT, Bayes-Genis, A, Tijssen, JGP, Pinto, YM and Kok, WE
Publicada:
17 abr 2018
Resumen:
BACKGROUND: The concept of natriuretic peptide guidance has been extensively studied in patients with chronic heart failure (HF), with only limited success. The effect of NT-proBNP (N-terminal probrain natriuretic peptide)-guided therapy in patients with acute decompensated HF using a relative NT-proBNP target has not been investigated. This study aimed to assess whether NT-proBNP-guided therapy of patients with acute decompensated HF using a relative NT-proBNP target would lead to improved outcomes compared with conventional therapy.
METHODS: We conducted a prospective randomized controlled trial to study the impact of in-hospital guidance for acute decompensated HF treatment by a predefined NT-proBNP target (>30% reduction from admission to discharge) versus conventional treatment. Patients with acute decompensated HF with NT-proBNP levels >1700 ng/L were eligible. After achieving clinical stability, 405 patients were randomized to either NT-proBNP-guided or conventional treatment (1: 1). The primary end point was dual: a composite of all-cause mortality and HF readmissions in 180 days and the number of days alive out of the hospital in 180 days. Secondary end points were all-cause mortality within 180 days, HF readmissions within 180 days, and a composite of all-cause mortality and HF readmissions within 90 days.
RESULTS: Significantly more patients in the NT-proBNP-guided therapy group were discharged with an NT-proBNP reduction of >30% (80% versus 64%, P=0.001). Nonetheless, NT-proBNP-guided therapy did not significantly improve the combined event rate for all-cause mortality and HF readmissions (hazard ratio, 0.96; 95% confidence interval, 0.72-1.37; P=0.99) or the median number of days alive outside of the hospital (178 versus 179 days for NT-proBNP versus conventional patients, P=0.39). Guided therapy also did not significantly improve any of the secondary end points.
CONCLUSIONS: The PRIMA II trial (Can NT-ProBNP-Guided Therapy During Hospital Admission for Acute Decompensated Heart Failure Reduce Mortality and Readmissions?) demonstrates that the guidance of HF therapy to reach an NT-proBNP reduction of >30% after clinical stabilization did not improve 6-month outcomes.
Filiaciones:
Stienen, S:
Acad Med Ctr, Dept Cardiol, Amsterdam, Netherlands
Salah, K:
Acad Med Ctr, Dept Cardiol, Amsterdam, Netherlands
Moons, AH:
Slotervaartziekenhuis, Dept Cardiol, Amsterdam, Netherlands
Bakx, AL:
BovenIJ Ziekenhuis, Dept Cardiol, Amsterdam, Netherlands
van Pol, P:
Alrijne Ziekenhuis, Dept Cardiol, Leiderdorp, Netherlands
Kortz, RAM:
Flevoziekenhuis, Dept Cardiol, Almere, Netherlands
Ferreira, JP:
Univ Porto, Fac Med, Cardiovasc Res & Dev Unit, Dept Physiol & Cardiothorac Surg, Porto, Portugal
Univ Lorraine, CHRU Nancy, INSERM, Ctr Invest Clin Plurithemat, Nancy, France
Marques, I:
Univ Porto, Inst Ciencias Biomed Abel Salazar, Ctr Hosp Porto, Dept Internal Med, Porto, Portugal
Schroeder-Tanka, JM:
St Lucas Andreas Ziekenhuis, Dept Cardiol, Amsterdam, Netherlands
Keijer, JT:
Tergooiziekenhuizen, Dept Cardiol, Blaricum, Netherlands
:
Hosp Badalona Germans Trias & Pujol, Dept Cardiol, Barcelona, Spain
Tijssen, JGP:
Acad Med Ctr, Dept Cardiol, Amsterdam, Netherlands
Pinto, YM:
Acad Med Ctr, Dept Cardiol, Amsterdam, Netherlands
Kok, WE:
Acad Med Ctr, Dept Cardiol, Amsterdam, Netherlands
Bronze
|