Patients in the highest quartile of NT-proBNP were older, more commonly women, and had more hypertension, atrial fibrillation, renal dysfunction, and pulmonary congestion on presentation. (all p<0.001). NT-proBNP was strongly associated with the primary end point (adjusted hazard ratio, 1.45 per doubling of NT-proBNP; [95% CI, 1.23-1.70]), adjusted for clinical variables and baseline hs-cTnT. NT-proBNP was also independently associated with all-cause death (adjusted hazard ratio, 1.74 [95% CI, 1.38-2.21]) and fatal or nonfatal MI or stroke (adjusted hazard ratio, 1.24 [95% CI, 1.05-1.45]). This evidence concerns the gene NPPB and Abnormal renal physiology.