title: Prediction of cardiogenic shock using plasma B-type natriuretic peptide and the N-terminal fragment of its pro-hormone [corrected] concentrations in ST elevation myocardial infarction: an analysis from the ASSENT-4 Percutaneous Coronary Intervention Trial.
abstract: OBJECTIVE
  Cardiogenic shock is a major cause of death in ST elevation myocardial infarction. We investigated whether determination of plasma [corrected] B-type natriuretic peptide and the N-terminal fragment of its pro-hormone in the acute phase of ST elevation myocardial infarction could identify patients prone to development of cardiogenic shock.
  
  
  METHODS
  Retrospective analysis of a multicenter, randomized open-label trial (ASSENT-4 PCI; ClinicalTrials.gov Identifier: NCT00168792).
  
  
  METHODS
  Plasma B-type natriuretic peptide and the N-terminal fragment of its pro-hormone were determined in available stored samples of 1016 ST elevation myocardial infarction patients without signs of cardiogenic shock at randomization to primary percutaneous coronary intervention or to full-dose tenecteplase before percutaneous coronary intervention. The end point of the present analysis was in-hospital cardiogenic shock.
  
  
  METHODS
  None.
  
  
  RESULTS
  In total, 57 (5.6%) patients had cardiogenic shock during index hospitalization. In-hospital cardiogenic shock increased precipitously with higher baseline concentrations of plasma B-type natriuretic peptide and the N-terminal fragment of its pro-hormone (B-type natriuretic peptide and the N-terminal fragment of its pro-hormone < or =67 pg/mL: 1.9%; 68-1482 pg/mL: 5.9%; >1482 pg/mL: 14.9%; p < .001). Higher plasma [corrected] B-type natriuretic peptide and the N-terminal fragment of its pro-hormone concentrations were predictors of in-hospital shock, especially among those patients with relatively low clinical risk (no requirement of inotropic support before angiography, systolic blood pressure >100 mm Hg, heart rate <100 bpm, Global Utilization of Streptikonase and Tissue-Plasminogen Activator for Occluded Coronary Arteries score of <122). In multivariate Cox regression analysis, higher plasma B-type natriuretic peptide and the N-terminal fragment of its pro-hormone concentrations remained significant predictors of shock, in addition to age, systolic blood pressure, heart rate, and randomization to facilitated percutaneous coronary intervention and Killip classification. Furthermore, plasma B-type natriuretic peptide and the N-terminal fragment of its pro-hormone significantly predicted in-hospital shock independently of the validated Global Utilization of Streptikonase and Tissue-Plasminogen Activator for Occluded Coronary Arteries score (p = .014).
  
  
  CONCLUSIONS
  Plasma B-type natriuretic peptide and the N-terminal fragment of its pro-hormone concentrations measured early in the acute phase of ST elevation myocardial infarction are useful in predicting the development of in-hospital cardiogenic shock.
authors.affiliation: Third Department of Medicine, Cardiology and Emergency Medicine, Wilhelminen Hospital, Vienna, Austria.
authors.forename: Rudolf
authors.initials: R
authors.lastname: Jarai
authors.forename: Kurt
authors.initials: K
authors.lastname: Huber
authors.forename: Kris
authors.initials: K
authors.lastname: Bogaerts
authors.forename: Peter R
authors.initials: PR
authors.lastname: Sinnaeve
authors.forename: Justin
authors.initials: J
authors.lastname: Ezekowitz
authors.forename: Allan M
authors.initials: AM
authors.lastname: Ross
authors.forename: Uwe
authors.initials: U
authors.lastname: Zeymer
authors.forename: Paul W
authors.initials: PW
authors.lastname: Armstrong
authors.forename: Frans J
authors.initials: FJ
authors.lastname: Van de Werf
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D015415:Biomarkers / Q000097:blood*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000150:complications* / Q000503:physiopathology / Q000601:surgery; D020097:Natriuretic Peptide, Brain / Q000097:blood* / Q000737:chemistry; D012189:Retrospective Studies; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000097:blood / Q000209:etiology*; D016019:Survival Analysis
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain