Can Pro-Brain Natriuretic Peptide Guided Therapy of Heart Failure Improve Heart Failure Morbidity and Mortality? - PRIMA
The goal of the trial was to evaluate N-terminal portion of probrain natriuretic peptide (NT-proBNP) guided management compared with clinically guided management in patients with heart failure.
NT-proBNP guided management would be more effective in preventing complications of heart failure.
Patients Enrolled: 345
Mean Follow Up: Median 702 days
Mean Patient Age: 71 years
Mean Ejection Fraction: 31%
- Patients admitted with decompensated heart failure with an elevated NT-proBNP level on admission that dropped at least 10% during hospitalization
- Significant cardiac arrhythmia
- Urgent surgical intervention
- Severe chronic obstructive pulmonary disease
- Recent pulmonary embolism
- Limited survival
- Patients on hemodialysis
- Number of days alive outside of the hospital
- Cardiovascular mortality
- Heart failure, cardiovascular and total hospitalization
- Death or hospitalization
- Use of evidence-based heart failure medications
- Analysis of patients who do not have a decrease in their NT-proBNP level
Patients admitted for worsening heart failure and whose NT-proBNP decreased during their admission were randomized at discharge to NT-proBNP guided management (n = 174) versus clinically guided management (n = 171).
Overall, 345 patients were randomized. The mean age was 71 years, 45% were women, 37% had a history of myocardial infarction, mean left ventricular ejection fraction was 31%, and median NT-proBNP level at admission was 8,034 pmol/L.
The occurrence of the primary outcome, number of days alive outside the hospital, was 685 with NT-proBNP guided management versus 664 with control (p = 0.49). Total mortality was 26.5% versus 33.3% (p = 0.21), respectively. There was no difference between the groups in any of the secondary outcomes.
Among patients admitted with decompensated heart failure, NT-proBNP guided therapy did not reduce the number of days alive outside the hospital or total mortality. This study reveals that NT-proBNP guided management of heart failure patients may not be effective, although NT-proBNP levels portend important prognostic information.
Eurlings LW, van Pol PE, Kok WE, et al. Management of Chronic Heart Failure Guided by Individual N-Terminal Pro–B-Type Natriuretic Peptide Targets: Results of the PRIMA (Can PRo-brain-natriuretic peptide guided therapy of chronic heart failure IMprove heart fAilure morbidity and mortality?) Study. J Am Coll Cardiol 2010;56:2090-2100.
Can Pro-Brain Natriuretic Peptide Guided Therapy of Heart Failure Improve Heart Failure Morbidity and Mortality? Main Outcome of the PRIMA-Study. Presented by Dr. Luc Eurlings at ACC.09/i2, Orlando, FL, March 2009.
Keywords: Myocardial Infarction, Heart Failure, Peptide Fragments, Stroke Volume, Natriuretic Peptide, Brain
< Back to Listings