title: B-type natriuretic peptide as a predictor of ischemia/reperfusion injury immediately after myocardial reperfusion in patients with ST-segment elevation acute myocardial infarction.
abstract: BACKGROUND
  In animal models of acute myocardial infarction (AMI), B-type natriuretic peptide (BNP) administered before and during coronary occlusion limits infarct size. However, the relation between plasma BNP levels and ischemia/reperfusion injury remains unclear.
  
  
  METHODS
  302 patients with ST-segment elevation AMI (STEMI) received emergency percutaneous coronary intervention within six hours from the onset. The patients were divided into two groups according to the plasma BNP level before angiography: group L (n=151), BNP ≤ 32.2 pg/ml; group H (n=151), BNP >32.2 pg/ml. The Selvester QRS-scoring system was used to estimate infarct size.
  
  
  RESULTS
  The rate of ischemia/reperfusion injury immediately after reperfusion, defined as reperfusion ventricular arrhythmias (26% vs. 11%, p=0.001) and ST-segment re-elevation (44% vs. 22%, p=0.008), was higher in group L than in group H. Group L had a greater increase in the QRS score during percutaneous coronary intervention (3.55 ± 0.17 vs. 2.09 ± 0.17, p<0.001) and a higher QRS score 1 h after percutaneous coronary intervention (5.77 ± 0.28 vs. 4.51 ± 0.28, p=0.002). On multivariate analysis, plasma BNP levels in the lower 50th percentile were an independent predictor of reperfusion injury (odds ratio, 2.620; p<0.001). The odds ratios of reperfusion injury according to decreasing quartiles of BNP level, as compared with the highest quartile, were 1.536, 3.692 and 4.964, respectively (p trend=0.002).
  
  
  CONCLUSIONS
  Plasma BNP level before percutaneous coronary intervention may be a predictor of ischemia/reperfusion injury and the resultant extent of myocardial damage. Our findings suggest that high plasma BNP levels might have a clinically important protective effect on ischemic myocardium in patients with STEMI who receive percutaneous coronary intervention.
authors.affiliation: Division of Cardiology, Fujisawa City Hospital, Japan hiroking@gamma.ocn.ne.jp.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Arakawa
authors.affiliation: Division of Cardiology, Fujisawa City Hospital, Japan.
authors.forename: Hideo
authors.initials: H
authors.lastname: Himeno
authors.affiliation: Division of Cardiology, Fujisawa City Hospital, Japan.
authors.forename: Jin
authors.initials: J
authors.lastname: Kirigaya
authors.affiliation: Division of Cardiology, Fujisawa City Hospital, Japan.
authors.forename: Fumie
authors.initials: F
authors.lastname: Otomo
authors.affiliation: Division of Cardiology, Fujisawa City Hospital, Japan.
authors.forename: Kensuke
authors.initials: K
authors.lastname: Matsushita
authors.affiliation: Division of Cardiology, Fujisawa City Hospital, Japan.
authors.forename: Hidefumi
authors.initials: H
authors.lastname: Nakahashi
authors.affiliation: Division of Cardiology, Fujisawa City Hospital, Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Shimizu
authors.affiliation: Division of Cardiology, Fujisawa City Hospital, Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Nitta
authors.affiliation: Division of Cardiology, Fujisawa City Hospital, Japan.
authors.forename: Tetsu
authors.initials: T
authors.lastname: Takamizawa
authors.affiliation: Division of Cardiology, Fujisawa City Hospital, Japan.
authors.forename: Hideto
authors.initials: H
authors.lastname: Yano
authors.affiliation: Division of Cardiology, Fujisawa City Hospital, Japan.
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Endo
authors.affiliation: Division of Cardiology, Fujisawa City Hospital, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Kanna
authors.affiliation: Division of Cardiology, Yokohama City University Medical Center, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Kimura
authors.affiliation: Department of Medical Science and Cardiorenal Medicine, Yokohama City University, School of Medicine, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Umemura
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000601:surgery; D015425:Myocardial Reperfusion / Q000009:adverse effects / Q000379:methods*; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods; D011237:Predictive Value of Tests; D015427:Reperfusion Injury / Q000097:blood*
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain
keywords: B-type natriuretic peptide; Ischemia reperfusion injury; myocardial infarction