High brain natriuretic peptide level is associated with severe stroke in patients taking oral anticoagulants: A sub-analysis of the PASTA registry study.

Background: Brain natriuretic peptides (BNP) are an important diagnostic and prognostic marker in patients with heart failure. However, the relationship between BNP levels and stroke severity in patients with atrial fibrillation (AF) remains unelucidated. In this study, we aimed to investigate the association between stroke severity at admission and BNP levels.
Methods: In this prospective observational study, we used data from 513 patients with AF and acute ischemic stroke treated with oral anticoagulants (OAC) registered in the Multicenter Prospective Analysis of Stroke Patients Taking Oral Anticoagulants study. The patients were divided into two groups: high-BNP (≥200 pg/mL) and low-BNP level (<200 pg/mL) groups. We compared the clinical characteristics between the two groups and determined the effect of BNP levels on stroke severity on admission.
Results: Among the 513 enrolled patients, 248 (females, n = 30; median age, 82 years) and 265 (females, n = 76; median age, 71 years) were assigned to the high- and low-BNP level groups, respectively. The high-BNP level group had a higher proportion of patients with severe stroke (National Institutes of Health Stroke Scale score, ≥10) on admission (49.2% vs. 32.8%, p = 0.002) and major vessel occlusion (57.5% vs. 39.2%, p < 0.0001) than that had by the low-BNP level group. Multivariate analysis showed that high BNP level was independently associated with severe stroke on admission (odds ratio 1.07, 95% confidence interval 1.00-1.15; p = 0.0478).
Conclusions: High BNP level compared with low BNP level was associated with severe stroke and major vessel occlusion, even before OAC treatment.
Competing Interests: Declaration of competing interest S.S. received research funding from the All Japan Coffee Association and lecture fees from Daiichi Sankyo Co. Ltd. and Eisai Co., Ltd. Y.I. received lecture fees from Bayer Healthcare Co. Ltd., Pfizer Japan Inc., Nippon Boehringer Ingelheim Co. Ltd., Takeda Pharmaceutical Co. Ltd., Otsuka Pharmaceutical Co., Ltd., and Daiichi Sankyo Co. Ltd. Research funding was obtained from Sanofi Co., Ltd. Y.Y. received lecture fees from Daiichi Sankyo Co. Ltd. T.K. received lecture fees from Bayer Healthcare Co. Ltd., Nippon Boehringer Ingelheim Co. Ltd., and Daiichi Sankyo Co. Ltd. S.F. received personal lecture fees (not related to the current work) from Takeda Pharmaceutical Co. Ltd., Nippon Boehringer Ingelheim, Co. Ltd., Otsuka Pharmaceutical, Co. Ltd., Bayer Yakuhin, Ltd., Pfizer Japan Inc., Daiichi Sankyo Co. Ltd., Eisai Co. Ltd., and Bristol-Myers Squibb Co. Ltd. K.K. received lecture fees from Bristol-Myers Squibb Co. Ltd., Nippon Boehringer Ingelheim Co. Ltd., Bayer Healthcare Co. Ltd., and Daiichi Sankyo Co. Ltd. Research funding from Nippon Boehringer Ingelheim Co. Ltd. And Daiichi Sankyo Co. Ltd.
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