N-terminal pro-brain natriuretic peptide is a biomarker of congestive heart failure and predictive of 30-day untoward clinical outcomes in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention.
BACKGROUND
Increased levels of N-terminal pro-brain natiuretic peptide (NT-proBNP) are now recognized as a new and useful biochemical marker that is predictive of clinical outcomes in patients with congestive heart failure (CHF). However, an association between an increased circulating level of this biomarker and clinical outcomes in patients following acute myocardial infarction (AMI) has not been fully delineated. Thus, the purpose of this study was to test whether NT-proBNP can predict prognosis in patients following ST-segment elevated AMI.


RESULTS
A prospective cohort study of 242 consecutive patients with ST-segment elevated AMI of onset <12 h who underwent primary percutaneous coronary intervention (PCI) was conducted. Blood samples for plasma concentration of NT-proBNP were collected following vascular puncture. Univariate analysis demonstrated that the 30-day composite major adverse clinical outcomes (MACO) [advanced Killip score > or =3, functional class > or =3 of CHF and 30-day mortality] were strongly associated with elevated NT-proBNP (>243 pg/ml) (p<0.0001), unsuccessful reperfusion (final thrombolysis in myocardial infarction flow < or =2) (p<0.0001), left ventricular ejection fraction (LVEF) <45% (p<0.0001), diabetes mellitus (DM) (p=0.0004) and multivessel disease (p=0.0005). Multiple stepwise logistic regression analysis demonstrated that elevation of NT-proBNP (p=0.0002), LVEF < 45% (p=0.0003), DM (p=0.0007), unsuccessful reperfusion (p=0.006), and age (> or =70 years) (p=0.031) are independent predictors of 30-day MACO. Additionally, elevation of NT-proBNP, together with advanced Killip score and unsuccessful reperfusion, are significant independent predictors of increased 30-day mortality (all p values <0.005).


CONCLUSIONS
Increased NT-proBNP level was the most independent predictor of 30-day MACO in patients with ST-segment elevated AMI undergoing primary PCI.
Wu
Chiung-Jen
CJ
Division of Cardiology, Chang Gung Memorial Hospital, Kaohsiung, 123 Ta-Pei Road, Niao Sung Hsiang, Kaohsiung Hsien 83301, Taiwan, ROC.
Chang
Hsueh-Wen
HW
Hung
Wei-Chin
WC
Yang
Cheng-Hsu
CH
Chen
Yen-Hsun
YH
Su
Cheng-Yur
CY
Yip
Hon-Kan
HK
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D015415:Biomarkers / Q000097:blood; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000150:complications / Q000628:therapy; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome
D015415:Biomarkers; D020097:Natriuretic Peptide, Brain