Predictive Value of NT-proBNP,NPHR Combined with GRACE Score for New-Onset Acute Heart Failure After PCI in Elderly Patients with Acute Myocardial Infarction

SU Xile; SHANG Xiaomeng; ZHOU Kaige; WU Leiming

doi:10.3969/j.issn.1004-437X.2026.14.018

Abstract：Objective To analyze the predictive value of N-terminal pro-brain natriuretic peptide(NT-proBNP),neutrophil/hemoglobin ratio(NPHR)combined with global registry of acute coronary events(GRACE)score for new-onset acute heart failure after percutaneous coronary intervention(PCI)in elderly patients with acute myocardial infarction(AMI).Methods A total of 299 elderly patients with AMI who underwent PCI in Xinmi Hospital of Traditional Chinese Medicine from August 2023 to August 2025were selected.According to whether new acute heart failure occurred after PCI,they were divided into occurrence group(35 cases)and non-occurrence group(264 cases).Another 80 patients from September to November 2025 were selected as the validation set for prospective cohort validation.The baseline data and NT-proBNP,NPHR and GRACE scores before PCI were compared between the two groups.Multivariate logistic regression was used to analyze the effects of NT-proBNP,NPHR and GRACE scores on new-onset acute heart failure after PCI in elderly AMI patients.Receiver operating characteristic(ROC)curve was used to analyze the value of NT-proBNP,NPHR and GRACE in predicting new-onset acute heart failure after PCI in elderly AMI patients.The accuracy-recall(PR)curve was used to analyze the robustness of the combined performance in identifying positive categories.The calibration curve and clinical decision analysis curve were used to evaluate the calibration and clinical utility of the combined prediction.Results Patients with atrial fibrillation in the occurrence group were more than those in the non-occurrence group,and LVEF was lower than that in the non-occurrence group,the differences were statistically significant(P＜0.05).The scores of NT-proBNP,NPHR and GRACE in the occurrence group were higher than those in the non-occurrence group,and the differences were statistically significant(P＜0.05).Multivariate logistic regression analysis showed that after adjusting for atrial fibrillation and left ventricular ejection fraction(LVEF),the increase of NT-proBNP,NPHR and GRACE score was still the related influencing factor of new acute heart failure after PCI in elderly patients with AMI(P＜0.05).ROC curve analysis showed that the area under the curve of the combined prediction of NT-proBNP,NPHR and GRACE score was 0.866,and its predictive efficiency was better than that of each index alone(P＜0.05).Further drawing of the PR curve showed that the PR-AUC of the combination of the three was 0.837(95％CI:0.818-0.897),suggesting that the recognition performance of the combination of the three in the positive category was robust.In the validation set,the area under the ROC curve of the combined prediction scheme was 0.860,which was not significantly different from that of the modeling set(0.866)(P＞0.05),suggesting that the model had good extrapolation performance.The calibration curve was drawn and showed that the joint prediction results of the three were in good agreement with the actual probability,suggesting that the model had good calibration.The clinical decision analysis curve was drawn and showed that the use of joint prediction to guide clinical could bring positive net benefits(threshold probability 0.13-0.63).Conclusion NT-proBNP,NPHR combined with GRACE score can improve the predictive value of new-onset acute heart failure after PCI in elderly patients with AMI,provide a new scheme for early identification of high-risk groups,which may help to optimize the allocation of medical resources and reduce the occurrence of acute heart failure.