Serum B-type natriuretic peptide levels on admission predict not only short-term death but also angiographic success of procedure in patients with acute ST-elevation myocardial infarction treated with primary angioplasty.
BACKGROUND
B-type natriuretic peptide (BNP) levels are predictive of short-term death in patients with acute coronary syndromes. Few data are available for BNP levels obtained on admission in patients with acute ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI).


METHODS
Blood samples for BNP estimation, obtained on admission in 126 consecutive patients (mean age, 58.8 +/- 10.7 years) with STEMI, were measured at the bedside by using a simple point-of-care test in a 15-minute period before PCI. Follow-up up to 42 days was performed.


RESULTS
A baseline BNP value of 331 pg/mL had a sensitivity of 87.9% and a specificity of 90% for predicting death in a follow-up study. There was no difference in subgroups by median BNP (100 pg/mL) in Thrombolysis In Myocardial Infarction (TIMI) flow grade 3 before PCI, although higher BNP levels were observed among patients with TIMI <3 after PCI than among those with TIMI 3 (356.7 +/- 350.8 vs 144.9 +/- 191.2 pg/mL; P <.0001). In multivariate logistic regression analysis, admission BNP was the independent predictor for the following: death (odds ratio [OR], 16.3; 95% confidence interval [CI], 1.4 to 186.7; P =.03), TIMI grade <3 after PCI (OR, 3.4; 95% CI, 1.2 to 9.6; P =.02), and the no-reflow phenomenon (OR, 6.2; 95% CI, 1.7 to 23; P =.007) after adjusting for other variables.


CONCLUSIONS
BNP levels obtained on admission are a powerful, independent predictor of short-term death and angiographic success after PCI in patients with STEMI. The no-reflow phenomenon may be predicted in STEMI on the basis of high serum BNP values on admission.
First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland. marcin.grabowski@amwaw.edu.pl
Marcin
M
Grabowski
Krzysztof J
KJ
Filipiak
Grzegorz
G
Karpinski
Dominik
D
Wretowski
Adam
A
Rdzanek
Zenon
Z
Huczek
Grzegorz J
GJ
Horszczaruk
Janusz
J
Kochman
Robert
R
Rudowski
Grzegorz
G
Opolski
D000328:Adult; D000367:Age Factors; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D003131:Combined Modality Therapy; D004562:Electrocardiography; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000401:mortality* / Q000628:therapy; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011379:Prognosis; D012372:ROC Curve; D012307:Risk Factors; D016019:Survival Analysis
D020097:Natriuretic Peptide, Brain