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Background: Optimal risk stratification in heart failure patients surviving an episode of acute decompensation has not yet been established. We investigated whether a lack of significant decrease in plasma levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) during hospital stay can identify patients at high risk of poor outcome., Methods: We studied 103 consecutive patients with acute heart failure (86 men, age: 64 + or - 13 years, LVEF: 28 + or - 8%). The primary end-point was all-cause mortality at 1-year follow-up., Results: Median plasma NT-proBNP on admission was 6116 pg/mL (upper/lower quartiles: 3575, 10,958) vs. 2930 pg/mL (1674, 5794) after clinical stabilization (7 + or - 3 days after admission). During the 1-year follow-up 29 (28%) patients died. A decrease in plasma NT-proBNP during clinical recovery (expressed as percentage of NT-proBNP on admission) predicted favorable outcome in the single predictor analysis (p<0.001) and multivariable analyses (p<0.001). Receiver operating characteristic curve analysis revealed that 65% was the cut-off value for NT-proBNP decrease having best prognostic accuracy for predicting death (sensitivity 90%, specificity 37%, AUC=0.65, 95% CI: 0.54-0.74). Kaplan-Meier analysis showed that 12-month survival was 92% (95% CI: 81-100%) for patients with > pr = 65% NT-proBNP decrease vs 66% (95% CI: 56-76%) in those with <65% NT-proBNP decrease (p=0.02)., Conclusions: The magnitude of plasma NT-proBNP decrease in patients with acute heart failure is helpful in discrimination of patients at high risk of death. Plasma NT-proBNP level monitoring is important for risk stratification in this group of patients.

Introduction: Monitoring of natriuretic peptide concentration may be useful for the identification of high-risk patients presenting with decompensated chronic heart failure (CHF)., Aim: Assessment of the predicting value of a significant decrease (by > or =20% vs. baseline) of N-terminal proBNP (NTpro-BNP, ROCHE) concentration during hospitalisation in patients with decompensated CHF., Methods: This study involved 54 patients admitted to our centre because of CHF decompensation. Concentration of NTpro-BNP was measured on admission and at discharge from hospital. Primary end-points of this study were overall mortality and mortality with a number of cardiovascular-related readmissions., Results: Mean NTpro-BNP concentration on admission was 7435+/-10040 pg/ml and at the time of discharge from hospital -- 4816+/-7822 pg/ml. In 31 (57%) patients a significant decrease (> or =20% vs baseline value) in NTpro-BNP level (mean: -58%+/-21%) was noted, while in the remainder (23 patients; 43%) neither an increase nor a decrease in NTpro-BNP levels was observed (mean: +72%+/-132%) despite optimal treatment and stabilisation of the clinical status. The mean follow-up duration was 358+/-240 days. Cox analysis showed that the absence of significant NTpro-BNP level decrease was associated with an increased risk of death -- RR: 3.69 (95% CI: 1.10-12.37; p=0.035) and was the single independent risk factor for readmission due to cardiovascular-related reasons and/or death -- RR: 2.29 (95% CI: 1.20-4.35; p=0.01). In the group of 23 patients with an increase or decrease in NTpro-BNP concentration of more than or equal to 20%, the survival rate was 65% vs. 87% in the remainder (p=0.02)., Conclusions: The lack of a significant (> or =20%) decrease of NTpro-BNP level during hospitalisation correlates with a higher mortality and rate of readmissions. NTpro-BNP level monitoring may be of clinical importance for risk stratification in patients hospitalised for decompensated CHF.

Background: The data regarding follow-up of high-risk patients after coronary rotational atherectomy (RA) are poor. Aim: The aim of this study was to evaluate the in-hospital and 6-month outcome of patients with uncrossable or undilatable lesions who were treated with RA. Material and methods: The RA was performed in 62 consecutive patients (mean EuroSCORE: 6.8 ±4) and all of them were enrolled. Major adverse cardiac events (MACE) were defined as all-cause death, cardiac death, stroke, myocardial infarction (MI), target lesion revascularization (TLR), and target vessel revascularization (TVR). Results: The procedural success rate was 94%. The incidence of MACE was 9.7% in hospital (6 MIs, 3 of them with signs of ischemia) and 9.7% at 6-month follow-up (2 deaths, 3 MIs, 1 TLR). Death occurred in 2 patients (3%): due to definite stent thrombosis, and because of acute heart failure in a patient with low ejection fraction (EF). Conclusions: In this very high risk population RA provides good outcomes with relatively low risk of MACE. [ABSTRACT FROM AUTHOR]