title: Serum N-terminal pro-B-type natriuretic peptide levels at the time of hospital admission predict of microvascular obstructions after primary percutaneous coronary intervention for acute ST-segment elevation myocardial infarction.
abstract: BACKGROUND
  Significant microvascular obstruction (MVO) during primary percutaneous coronary intervention (PCI) may suggest severe myocardial damage. The predictive value of N-terminal pro-B-type natriuretic peptide levels (NT-proBNP) for MVO has not been previously evaluated.
  
  
  OBJECTIVE
  The purpose of the study was to determine whether NT-proBNP levels measured upon hospital admission of ST-segment elevation myocardial infarction (STEMI) patients receiving primary PCI have predictive value for MVO.
  
  
  METHODS
  NT-proBNP levels were obtained upon admission to the emergency department, for 41 acute STEMI patients. Cardiac contrast-enhanced magnetic resonance imaging (CE-MRI) was performed within 4 days after PCI. The optimal cut-off value to predict grade 3 MVO was determined using a receiver operating characteristic (ROC) curve. Multivariate regression analysis was performed to determine predictors for grade 3 MVO.
  
  
  RESULTS
  MVO grade correlated with left ventricular ejection fraction (LVEF; r =-0.383, P = 0.013), peak serum creatine kinase MB iso-enzyme (CK-MB; r = 0.470, P = 0.002), and NT-proBNP levels (r = 0.357, P = 0.022). The optimal cut-off value to predict grade 3 MVO was an NT-proBNP level of ≥80 pg/mL. Multivariate regression analysis, including LVEF, peak CK-MB, and an NT-proBNP ≥80 pg/mL revealed that only an NT-proBNP ≥80 pg/mL was an independent factor related to grade 3 MVO.
  
  
  CONCLUSIONS
  NT-proBNP levels upon hospital admission have a predictive value for MVOs. Further study is needed to determine if protective treatment strategies are warranted in STEMI patients with high NT-proBNP levels at presentation.
authors.affiliation: Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Min-Kyung
authors.initials: MK
authors.lastname: Kim
authors.forename: Woo-Young
authors.initials: WY
authors.lastname: Chung
authors.forename: Young-Seok
authors.initials: YS
authors.lastname: Cho
authors.forename: Sang-Il
authors.initials: SI
authors.lastname: Choi
authors.forename: In-Ho
authors.initials: IH
authors.lastname: Chae
authors.forename: Dong-Ju
authors.initials: DJ
authors.lastname: Choi
authors.forename: Young-Bae
authors.initials: YB
authors.lastname: Park
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data*; D015415:Biomarkers; D003287:Contrast Media; D017023:Coronary Angiography; D005260:Female; D006305:Health Status Indicators; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D055806:Microvessels / Q000473:pathology*; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000473:pathology / Q000628:therapy; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011379:Prognosis; D011446:Prospective Studies; D056910:Republic of Korea; D013223:Statistics as Topic; D013318:Stroke Volume; D013997:Time Factors; D016277:Ventricular Function, Left
chemical_list: D015415:Biomarkers; D003287:Contrast Media; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain