title: Comparison of usefulness of N-terminal pro-brain natriuretic peptide as an independent predictor of cardiac function among admission cardiac serum biomarkers in patients with anterior wall versus nonanterior wall ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.
abstract: The purpose of the present study was to determine the prognostic value of N-terminal pro-brain natriuretic peptide (NT-pro-BNP), among other serum biomarkers, on cardiac magnetic resonance (CMR) imaging parameters of cardiac function and infarct size in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. We measured NT-pro-BNP, cardiac troponin T, creatinine kinase-MB fraction, high-sensitivity C-reactive protein, and creatinine on the patients' arrival at the catheterization laboratory in 206 patients with ST-segment elevation myocardial infarction. The NT-pro-BNP levels were divided into quartiles and correlated with left ventricular function and infarct size measured by CMR imaging at 4 to 6 months. Compared to the lower quartiles, patients with nonanterior wall myocardial infarction in the highest quartile of NT-pro-BNP (> or = 260 pg/ml) more often had a greater left ventricular end-systolic volume (68 vs 39 ml/m(2), p <0.001), a lower left ventricular ejection fraction (42% vs 54%, p <0.001), a larger infarct size (9 vs 4 g/m(2), p = 0.002), and a larger number of transmural segments (11% of segments vs 3% of segments, p <0.001). Multivariate analysis revealed that a NT-pro-BNP level of > or = 260 pg/ml was the strongest independent predictor of left ventricular ejection fraction in patients with nonanterior wall myocardial infarction compared to the other serum biomarkers (beta = -5.8; p = 0.019). In conclusion, in patients with nonanterior wall myocardial infarction undergoing primary percutaneous coronary intervention, an admission NT-pro-BNP level of > or = 260 pg/ml was a strong, independent predictor of left ventricular function assessed by CMR imaging at follow-up. Our findings suggest that NT-pro-BNP, a widely available biomarker, might be helpful in the early risk stratification of patients with nonanterior wall myocardial infarction.
authors.affiliation: Department of Cardiology, University of Amsterdam Academic Medical Center, Amsterdam, The Netherlands. j.d.haeck@amc.uva.nl
authors.forename: Joost D E
authors.initials: JD
authors.lastname: Haeck
authors.forename: Niels J W
authors.initials: NJ
authors.lastname: Verouden
authors.forename: Wichert J
authors.initials: WJ
authors.lastname: Kuijt
authors.forename: Karel T
authors.initials: KT
authors.lastname: Koch
authors.forename: Jan P
authors.initials: JP
authors.lastname: Van Straalen
authors.forename: Johan
authors.initials: J
authors.lastname: Fischer
authors.forename: Maarten
authors.initials: M
authors.lastname: Groenink
authors.forename: Luc
authors.initials: L
authors.lastname: Bilodeau
authors.forename: Jan G P
authors.initials: JG
authors.lastname: Tijssen
authors.forename: Mitchell W
authors.initials: MW
authors.lastname: Krucoff
authors.forename: Robbert J
authors.initials: RJ
authors.lastname: De Winter
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D056988:Anterior Wall Myocardial Infarction / Q000097:blood* / Q000175:diagnosis / Q000628:therapy; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D052276:Creatine Kinase, BB Form / Q000097:blood; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000175:diagnosis / Q000628:therapy; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010343:Patient Admission; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D013318:Stroke Volume; D016277:Ventricular Function, Left / Q000502:physiology*
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D002097:C-Reactive Protein; D052276:Creatine Kinase, BB Form