Admission BNP-dominant biomarker phenotypes and in-hospital heart failure or cardiogenic shock in STEMI: a retrospective research note

OBJECTIVE: To assess, in a single-center retrospective cohort, whether admission B-type natriuretic peptide (BNP)-dominant biomarker phenotypes incorporating D-dimer are associated with in-hospital heart failure or cardiogenic shock (HF/CS) in patients with ST-segment elevation myocardial infarction (STEMI). RESULTS: Among 509 unique STEMI admissions, 467 had analyzable admission timestamps. The biomarker-enriched cohort included 140 patients with BNP and D-dimer measured within 24 h; 64 (45.7%) developed HF/CS. In the complete-case adjusted cohort (n = 136; 62 events), an equal-weight burden score [z(ln BNP) + z(ln D-dimer)] was associated with HF/CS (adjusted odds ratio [OR] 4.04, 95% confidence interval [CI] 1.84-8.92). BNP alone showed a similarly strong association (adjusted OR 3.75, 95% CI 1.86-7.60) and a slightly higher apparent area under the curve (0.859 vs. 0.849), indicating that the signal was mainly BNP-driven. The high BNP/high D-dimer phenotype had the highest HF/CS rate (80.9%). These findings should be interpreted as exploratory association and risk-enrichment observations rather than validated prediction or a complete assessment of congestion status.