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Does NT-proBNP Improve the Canadian Syncope Risk Score?

May 27, 2020

Written by Clay Smith

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N-terminal pro-B-type natriuretic peptide (NT-proBNP) did not improve upon the Canadian Syncope Risk Score (CSRS) in risk stratifying adults in the ED with syncope.

Why does this matter?
Last year, biomarkers alone – high sensitivity troponin and NT-proBNP – were found to have an independent association with mortality and serious adverse outcomes in patients with syncope. Does NT-proBNP add anything to the CSRS?

CHF biomarker for syncope…
This was a multicenter, prospective study of 1,452 adult patients with syncope who presented to the ED. They found that adding NT-proBNP to the CSRS identified 3% more people with serious adverse events (SAE). However, NT-proBNP misclassified 2% without SAE as not being low risk. There was no overall effect on diagnostic accuracy (c-statistic, a.k.a. area under the curve, 0.892 CSRS vs. 0.900 CSRS+NT-proBNP).

This key figure tells the story.

From cited article

Does N-Terminal Pro-B-Type Natriuretic Peptide Improve the Risk Stratification of Emergency Department Patients With Syncope? Ann Intern Med. 2020 May 19;172(10):648-655. doi: 10.7326/M19-3515. Epub 2020 Apr 28.

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What are your thoughts?