High plasma BNP concentration associates with clinical outcome after mechanical thrombectomy: Post hoc analysis of SKIP.

Objectives: Heart failure may result in reduced brain perfusion, limiting the blood flow needed to achieve clinical recovery. We investigated whether plasma levels of brain natriuretic peptide (BNP), a biological marker of heart failure, were related to clinical outcomes after mechanical thrombectomy (MT).
Materials and Methods: Data were analyzed from stroke patients with internal carotid or middle cerebral artery occlusion enrolled in the SKIP trial for whom plasma level of BNP was evaluated on admission. Favorable outcome was defined as a modified Rankin scale score of 0-2 at 3 months.
Results: Among 169 patients (median age, 74 years; 62% men, median National Institutes of Health Stroke Scale score, 18), 104 (62%) achieved favorable outcomes. Median plasma BNP level was lower in the favorable outcome group (124.1 pg/mL; interquartile range [IQR], 62.1-215.5 pg/mL) than in the unfavorable outcome group (198.0 pg/mL; IQR, 74.8-334.0 pg/mL; p=0.005). In multivariate regression analysis, the adjusted odds ratio for BNP for favorable outcomes was 0.971 (95% confidence interval, 0.993-0.999; p=0.048). At 3 months after onset, the favorable outcome rate was lower in the ≥186 pg/mL group (45%) than in the <186 pg/mL group (72%; p=0.001). This significant difference remained regardless of the presence of atrial fibrillation (AF), with rates of 47% and 76%, respectively, in AF patients (p=0.003) and 33% and 68%, respectively, in patients without AF (p=0.046).
Conclusion: High plasma BNP concentration appears associated with unfavorable outcomes after MT.
Competing Interests: Declaration of competing interest Kazumi Kimura received lecture fees from Bristol-Myers Squibb Co. Ltd., Nippon Boehringer Ingelheim Co. Ltd., Bayer Healthcare Co. Ltd., and Daiichi Sankyo Co.; research funding from Nippon Boehringer Ingelheim Co. Ltd., Daiichi Sankyo Co., Pfizer Japan Inc., Medtronic Co. Ltd., and Teijin Pharma Ltd.; and personal funding from the 38th Mihara Cerebrovascular Disorder Research Promotion Fund Ltd. Masataka Takeuchi received lecture fees from Stryker Co. Ltd. Shigeru Fujimoto received lecture fees from Nippon Boehringer Ingelheim Co. Ltd., Daiichi Sankyo Co. Ltd., Pfizer Japan Inc., Bristol-Myers Squibb Co. Ltd., Bayer Healthcare Co. Ltd., and Takeda Pharmaceutical Co. Ltd. Teruyuki Hirano received lecture fees from Bayer Healthcare Co. Ltd., Daiichi Sankyo Co. Ltd., Nippon Boehringer Ingelheim Co. Ltd., Bristol-Myers Squibb Co. Ltd., Medtronic Co. Ltd, Sanofi Co. Ltd. Otsuka Pharmaceutical Co. Ltd., Mitsubishi Tanabe Pharma Co., CSL Behring K.K., Astellas Pharma Inc., and Pfizer Japan Inc. Yasuhiro Nishiyama received lecture fees from Daiichi Sankyo Co. Ltd. Yasuyuki Iguchi 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.; and research funding from Sanofi Co. Ltd. Yuki Kamiya received lecture fees from Daiichi Sankyo Co. Ltd.; and research funding from Bristol-Myers Squibb Co. Ltd. Yuji Matsumaru received lecture fees from Medtronic Co. Ltd, Stryker Co. Ltd, Sanofi Co. Ltd., Daiichi Sankyo Co. Ltd., Otsuka Pharmaceutical Co. Ltd., and Biomedical solutions.
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