Relation of N-terminal pro-brain natriuretic peptide and new-onset atrial fibrillation in patients with acute coronary syndrome: a systematic review and meta-analysis

Abstract

Background: Several observational studies evaluated the associations of baseline N-terminal pro-brain natriuretic peptide (NT-proBNP) and new-onset atrial fibrillation (AF) in patients with acute coronary syndrome (ACS), but the results were contradictory.

Methods: Electronic bibliographic databases were searched from inception to May 2015, and the results reviewed by two independent reviewers. Pooled standardized mean difference (SMD) and 95% confidence interval (CI) were calculated to assess associations between NT-proBNP levels and new-onset AF in patients with ACS. We performed sensitivity analyses to explore the potential sources of heterogeneity and estimated publication biases.

Results: Six papers, including 5861 patients (438 with AF and 5423 without AF) with ACS were analyzed. Overall, the NT-proBNP levels were higher in patients with new-onset AF than controls without AF. The SMD of the NT-proBNP levels between the patients with and those without AF was 0.53 units (95% CI 0.37–0.70), test for overall effect z-score =6.30 (p < 0.00001). The heterogeneity test showed that there were moderate differences between individual studies (p = 0.02; I² =62%). Further analysis revealed that differences of ethnic groups and the sample size of studies possibly account for this heterogeneity.

Conclusions: In spite of moderate heterogeneity across the enrolled studies, our meta-analysis suggests that increased NT-proBNP levels are associated with greater risk of new-onset AF with ACS, which indicates that NT-proBNP levels may be a useful biomarker in predicting new-onset AF in patients with ACS.

Keywords:

• Acute coronary syndrome
• atrial fibrillation
• N-terminal pro-brain natriuretic peptide

Acknowledgements

This work was partially supported by the National Natural Scientific Foundation of China (No. 81473471), the Postdoctoral Science Foundation of China (No. 2015M570701) and Science Foundation of Guangdong Province (No. 2015A030310437).

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.