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

Abstract:

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. CLINICAL TRIAL REGISTRATION:URL: http://www.trialregister.nl. Unique identifier: NTR3279.

journal_name

Circulation

journal_title

Circulation

authors

Stienen S,Salah K,Moons AH,Bakx AL,van Pol P,Kortz RAM,Ferreira JP,Marques I,Schroeder-Tanka JM,Keijer JT,Bayés-Genis A,Tijssen JGP,Pinto YM,Kok WE

doi

10.1161/CIRCULATIONAHA.117.029882

subject

Has Abstract

pub_date

2018-04-17 00:00:00

pages

1671-1683

issue

16

eissn

0009-7322

issn

1524-4539

pii

CIRCULATIONAHA.117.029882

journal_volume

137

pub_type

杂志文章,多中心研究,随机对照试验
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    pub_type: 临床试验,杂志文章,随机对照试验

    doi:

    authors:

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    更新日期:1982-07-01 00:00:00

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    doi:

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    更新日期:1994-11-01 00:00:00

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    pub_type: 杂志文章,多中心研究,随机对照试验

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    更新日期:1998-12-01 00:00:00

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