Role of NT-proBNP and Myeloperoxidase as Predictors of Abnormal Stress Test Results and Revascularization in Intermediate-Risk NSTE-ACS: A Prospective Study

Background: Biomarkers have emerged as a cost-effective tool to risk stratify patients presenting to the emergency department with chest pain. The measurement of serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) and myeloperoxidase (MPO) may improve the identification of patients who are more likely to have abnormal stress test results and require revascularization. Methods: In this prospective observational study, we evaluated the use of NT-proBNP and MPO in predicting abnormal stress testing results and revascularization in patients presenting to the ED with chest pain and an intermediate TIMI risk score. The serum levels of NT-proBNP and MPO were obtained at enrollment. Stress testing or coronary angiography was performed at the discretion of the treating physician. Clinical outcomes were followed at index hospitalization, 6 months, and 1 year. Results: A total of 485 patients were enrolled. NT-proBNP had a fair ability to predict abnormal stress testing results (AUC 0.69, p < 0.001). Based on the Mann–Whitney U test, there was a detectable difference in the median serum levels of both biomarkers among patients who did not undergo revascularization compared to patients who did undergo revascularization (NT-proBNP 70.5 vs. 250, p < 0.001, MPO 341 vs. 471, p < 0.001). NT-proBNP and MPO revealed a meaningful ability to predict revascularization in all patients (NT-proBNP AUC = 0.725, p < 0.001, MPO AUC = 0.653 p < 0.001). Conclusion: Elevated serum NT-proBNP was a fair predictor of abnormal stress test results. Furthermore, higher serum NT-proBNP and MPO levels were associated with revascularization events up to 1-year follow-up and were found to be meaningful predictors of coronary revascularization.