title: N-terminal pro-brain natriuretic peptide and the timing, extent and mortality in ST elevation myocardial infarction.
abstract: OBJECTIVE
  While natriuretic peptides have demonstrated diagnostic and prognostic potential in cardiac disorders, little is known about their relationship with the onset and quantification of myocardial infarction. The relationship of serial N-terminal pro-brain natriuretic peptide (NT-proBNP) with duration from symptom onset, infarct size and prognosis in ST elevation myocardial infarction (STEMI) patients treated with primary percutaneous intervention was examined.
  
  
  RESULTS
  Three hundred thirty-one STEMI patients in the COMplement inhibition in Myocardial infarction treated with Angioplasty (COMMA) trial, which evaluated pexelizumab versus placebo, were studied. NT-proBNP (pg/mL) was measured at randomization, 24 h and 72 h; creatine kinase-MB area under the curve was measured at 72 h; and QRS score was assessed at discharge. Prognosis was ascertained from the 90-day composite clinical outcome of death, shock, stroke and congestive heart failure. Multivariate logistical regression was used to adjust for baseline characteristics for models at randomization, 24 h and 72 h. NT-proBNP was higher in patients with longer time from symptom onset (P<0.001) and correlated with measures of infarct size, including the area under the curve (P<0.001) and QRS score (P<0.001). Patients reaching the primary end point had markedly higher NT-proBNP at each sampling period (P<0.001). NT-proBNP at all time points was the strongest independent predictor of the primary end point in the multivariate model: in the 24 h model, only age and 24 h NT-proBNP (C-index 0.83); and only age, Killip class and NT-proBNP was in the 72 h model (C-index 0.85).
  
  
  CONCLUSIONS
  Higher NT-proBNP at 24 h correlated with larger infarct size and worse clinical outcomes. NT-proBNP at baseline, 24 h and 72 h after presentation with acute STEMI, is an independent predictor of a poor outcome and adds clinically useful prognostic information.
authors.affiliation: University of Alberta, Edmonton, Canada.
authors.forename: Justin A
authors.initials: JA
authors.lastname: Ezekowitz
authors.forename: Pierre
authors.initials: P
authors.lastname: Théroux
authors.forename: Weiching
authors.initials: W
authors.lastname: Chang
authors.forename: Kenneth W
authors.initials: KW
authors.lastname: Mahaffey
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Granger
authors.forename: W D
authors.initials: WD
authors.lastname: Weaver
authors.forename: Judith S
authors.initials: JS
authors.lastname: Hochman
authors.forename: Paul W
authors.initials: PW
authors.lastname: Armstrong
mesh_terms: D017677:Age Distribution; D004562:Electrocardiography; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D015425:Myocardial Reperfusion; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011379:Prognosis; D017678:Sex Distribution; D016019:Survival Analysis
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain