title: Usefulness of preprocedural N-terminal pro-brain natriuretic peptide in predicting angiographic no-reflow phenomenon during stent implantation in patients with ST-segment elevation acute myocardial infarction.
abstract: The no-reflow phenomenon after primary percutaneous coronary intervention (PCI) is associated with larger infarct size, worse functional recovery, and higher incidence of complication after acute ST-elevation myocardial infarction (STEMI). The aim of this study was to assess the relation between preprocedural N-terminal pro-brain-type natriuretic peptide (NT-pro-BNP) and angiographic no-reflow phenomenon. We measured preprocedural serum NT-pro-BNP level in 159 consecutive patients with acute STEMI (aged 63 +/- 12 years; 72% men) before PCI. Angiographic no-reflow after PCI was defined as Thrombolysis In Myocardial Infarction (TIMI) flow grade <3. Baseline characteristics, including time from chest pain onset, between the no-reflow (n = 67) and normal-reflow groups (n = 92) were similar. NT-pro-BNP was significantly higher in the no-reflow group than the normal reflow group (1,982 +/- 3,314 vs 415 +/- 632 pg/ml; p = 0.005). Also, high-sensitivity C-reactive protein, monocytes, and troponin-T were significantly higher in the no-reflow group than the normal-reflow group. In the no-reflow group, NT-pro-BNP was much higher in patients with TIMI flow grade 0 (n = 41; 2,290 +/- 3,495 pg/ml) than those with TIMI grade 1 or 2 (n = 26; 1,575 +/- 2,340 pg/ml), but without significant difference. The area under the receiver-operating characteristic curve for NT-pro-BNP was 0.78, and the optimal cut-off value identified using receiver-operating characteristic curve analysis was 500 pg/ml. At the standard cut-off value of >500 pg/ml, increased NT-pro-BNP showed a high probability of no-reflow phenomenon (odds ratio 4.42, 95% confidence interval 1.15 to 17.00, p = 0.028). In conclusion, preprocedural NT-pro-BNP may be a strong predictor of the development of no-reflow phenomenon after PCI in patients with acute STEMI.
authors: The Heart Center of Chonnam National University Hospital, Gwangju, South Korea.
authors: Seo Na
authors: SN
authors: Hong
authors: Youngkeun
authors: Y
authors: Ahn
authors: Sun Ho
authors: SH
authors: Hwang
authors: Nam Sik
authors: NS
authors: Yoon
authors: Sang Rok
authors: SR
authors: Lee
authors: Jae Youn
authors: JY
authors: Moon
authors: Kye Hun
authors: KH
authors: Kim
authors: Young Joon
authors: YJ
authors: Hong
authors: Hyung Wook
authors: HW
authors: Park
authors: Ju Han
authors: JH
authors: Kim
authors: Myung Ho
authors: MH
authors: Jeong
authors: Jeong Gwan
authors: JG
authors: Cho
authors: Jong Chun
authors: JC
authors: Park
authors: Jung Chaee
authors: JC
authors: Kang
mesh_terms: D015415:Biomarkers / Q000097:blood; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation*; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000097:blood* / Q000000981:diagnostic imaging / Q000401:mortality; D004562:Electrocardiography; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology / Q000601:surgery*; D009204:Myocardial Revascularization / Q000379:methods; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011300:Preoperative Care; D011379:Prognosis; D011498:Protein Precursors; D012372:ROC Curve; D015607:Stents; D015996:Survival Rate
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; D011498:Protein Precursors; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain