title: Comparison of the usefulness of N-terminal pro-brain natriuretic peptide to other serum biomarkers as an early predictor of ST-segment recovery after primary percutaneous coronary intervention.
abstract: Data on the ability of serum biomarkers to predict microvascular obstruction by ST-segment recovery after primary percutaneous coronary intervention (PCI) is largely absent. Therefore, we determined the association between 5 serum biomarkers, obtained before emergency coronary angiography, and immediate ST-segment recovery in patients who had undergone primary PCI for ST-segment elevation myocardial infarction. We measured N-terminal pro-brain natriuretic peptide (NT-pro-BNP), cardiac troponin T, creatinine kinase-MB fraction, high-sensitivity C-reactive protein, and serum creatinine from blood samples obtained through the arterial sheath at the start of primary PCI. Serial 12-lead electrocardiograms were recorded in the catheterization laboratory before arterial puncture and at the end of the PCI. ST-segment recovery was defined as incomplete if <50%. Of 662 included patients with ST-segment elevation myocardial infarction, 338 (51%) had incomplete ST-segment recovery. An elevated NT-pro-BNP level (> or = 608 ng/L) was the strongest predictor of incomplete ST-segment recovery (adjusted odds ratio 2.6, 95% confidence interval 1.6 to 4.1; p <0.001) compared to other serum biomarkers and clinical predictors. An elevated NT-pro-BNP level was more strongly predictive in patients without a history of coronary artery disease or hypertension (adjusted odds ratio 4.7, 95% confidence interval 2.4 to 9.2; p <0.001). NT-pro-BNP was the best contributor to both net reclassification (0.43; p <0.001) and integrated discrimination improvement (0.04; p <0.001) when added to a multivariate model with clinical predictors of incomplete ST-segment recovery. In conclusion, NT-pro-BNP was the strongest independent predictor of ST-segment recovery at the end of primary PCI for ST-segment elevation myocardial infarction compared to the other serum biomarkers reflecting myocardial cell damage, renal function, and inflammation.
authors.affiliation: Department of Cardiology, Academic Medical Center, University of Amsterdam Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Niels J W
authors.initials: NJ
authors.lastname: Verouden
authors.forename: Joost D E
authors.initials: JD
authors.lastname: Haeck
authors.forename: Wichert J
authors.initials: WJ
authors.lastname: Kuijt
authors.forename: Nan
authors.initials: N
authors.lastname: van Geloven
authors.forename: Karel T
authors.initials: KT
authors.lastname: Koch
authors.forename: José P S
authors.initials: JP
authors.lastname: Henriques
authors.forename: Jan
authors.initials: J
authors.lastname: Baan
authors.forename: Marije M
authors.initials: MM
authors.lastname: Vis
authors.forename: Jan P
authors.initials: JP
authors.lastname: van Straalen
authors.forename: Johan
authors.initials: J
authors.lastname: Fischer
authors.forename: Jan J
authors.initials: JJ
authors.lastname: Piek
authors.forename: Jan G P
authors.initials: JG
authors.lastname: Tijssen
authors.forename: Robbert J
authors.initials: RJ
authors.lastname: de Winter
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D015415:Biomarkers / Q000097:blood*; D002097:C-Reactive Protein / Q000378:metabolism; D052279:Creatine Kinase, MB Form / Q000097:blood; D042241:Early Diagnosis; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007118:Immunoassay; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis* / Q000628:therapy; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D009391:Nephelometry and Turbidimetry; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D011498:Protein Precursors; D012189:Retrospective Studies
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; D011498:Protein Precursors; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D002097:C-Reactive Protein; D052279:Creatine Kinase, MB Form