N-terminal pro-B-type natriuretic peptide is associated with adverse short-term clinical outcomes in patients with acute ST-elevation myocardial infarction underwent primary percutaneous coronary intervention

BACKGROUND: Increased level of N-terminal pro-B type natriuretic peptide (NT-proBNP) is known to be associated with adverse outcome in patients with acute coronary syndrome. We evaluated early outcomes of patients with acute ST-elevated myocardial infarction (STEMI) according to the level of NT-proBNP as a substudy of Korean Acute Myocardial Infarction Registry (KAMIR). METHODS: Study population consisted of 1052 consecutive patients (mean 61.3+/-12.8 years old, male 73.2%) with STEMI of onset <12 h who underwent primary percutaneous coronary intervention (PCI) and who had baseline NT-proBNP level by electrochemiluminescence immnunoassay (ECLIA, NT-proBNP kit, Roche Diagnostics, Mannheim, Germany). The study subjects were divided into two groups according to the level of serum NT-proBNP. RESULTS: Patients with NT-proBNP level >991 pg/mL (n=329, 57.1% male) had lower left ventricle ejection fraction (LVEF) (47.8+/-11.8% vs. 53.0+/-10.8%, p<0.001), needed longer intensive care (3.7+/-3.6 days vs. 2.8+/-2.4 days, p<0.001) and had higher in-hospital mortality (1.3% vs. 7.4%, p<0.001) than those with NT-proBNP level991 pg/mL) (OR 3.70, 95% CI 1.14 to 12.03, p=0.030), old age (>or=70 years) (OR 4.71, 95% CI 1.43 to 15.52, p=0.011), advanced Killip class (>1) (OR 4.96, 95% CI 1.58 to 15.53, p=0.006), male gender (OR 5.67, 95% CI 1.45 to 22.21, p=0.013) and TIMI flow 0 before PCI (OR 5.04, 95% CI 1.08 to 23.41, p=0.039). CONCLUSIONS: This study suggests that baseline NT-proBNP level is associated with short term mortality in patients with STEMI underwent primary PCI.     

Prognostic value of N-terminal pro-B-type natriuretic peptide in patients with acute coronary syndromes undergoing left main percutaneous coronary intervention

BACKGROUND: Patients undergoing acute left main (LM) coronary artery revascularization have a high mortality and natriuretic peptides such as N-terminal pro-B-type (NT-proBNP) have been shown to have prognostic value in patients with acute coronary syndromes. The present study looked at the prognostic value of NT-proBNP in these patients. METHODS AND RESULTS: We studied all consecutive patients undergoing acute LM coronary artery percutaneous coronary intervention between January 2005 and December 2008 in whom NT-proBNP was measured (n=71). We analyzed the clinical characteristics and the short- and long-term outcomes in relation to NT-proBNP level at admission. Median NT-proBNP was 1,364 ng/L, ranging from 46 to 70,000 ng/L. NT-proBNP was elevated in 63 (89%) patients and was ≥1,000ng/L in 42 (59%). Log NT-proBNP (hazard ratio [HR] 3.51, 95% confidence interval [CI] 1.55-7.97, P=0.003) and left ventricular ejection fraction (HR 0.95, 95%CI 0.91-0.99, P=0.007) were predictors for all-cause mortality. Log NT-proBNP was the only independent significant predictor of cardiovascular mortality. In-hospital mortality was 0% for patients with NT-proBNP <1,000, but 17% for those with NT-proBNP ≥1,000 (P=0.036). Conclusions: NT-proBNP is a strong predictor of outcome in patients undergoing acute LM coronary artery stenting. Mortality in such patients is high, but those with NT-proBNP < 1,000ng/L may have a favorable short- and long-term prognosis. Further research, including a larger patient population, is needed to determine the optimal cut-off value for NT-proBNP in patients undergoing acute LM coronary artery intervention.     

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

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. Hypothesis: 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. Conclusion: 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. (J Interven Cardiol 2011;24:34–41)     

血浆氨基末端脑钠肽前体与急性心肌梗死相关性临床研究

目的 探讨氨基末端脑钠肽前体(NT-proBNP)对急性心肌梗死(AMI)诊断的临床意义.方法 选取2012年5月至2014年10月在我院心内科住院诊断为急性心肌梗死患者188例(AMI组)及诊断为非急性心肌梗死患者114例(对照组),统计患者基本临床资料及入院24h内实验室检查结果,分析NT-proBNP与AMI的相关性.结果 AMI组与对照组相比,在年龄、性别、高血压史、吸烟史、饮酒史、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)上未见统计学差异,糖尿病史、NT-proBNP、肌酸激酶同工酶(CK-MB)、肌红蛋白(MYO)、超敏肌钙蛋白Ⅰ(ultra-TnⅠ)、丙氨酸氨基转氨酶(ALT)、天门冬氨酸氨基转移酶(AST)、血糖(Glu)比较,差异有统计学意义.NT-proBNP与ultra-TnⅠ之间存在良好的相关关系(r2=0.746,r=0.864,P＜0.01).ROC曲线显示,AUCM-proBNP=0.952,Cut-offNT-proBNP=246.82 pg/ml,诊断急性冠脉综合征灵敏度为87.9％,特异度为81.3％.结论 氨基末端脑钠肽前体对急性心肌梗死的早期诊断具有较好的诊断价值.     

Use of N-terminal pro-B-type natriuretic peptide to detect myocardial ischemia

Purpose

To evaluate the utility of plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels to detect myocardial ischemia.

Methods

We conducted a prospective observational study in 260 consecutive patients with suspected myocardial ischemia referred for rest/ergometry myocardial perfusion single-photon emission computed tomography. Levels of NT-proBNP were determined before and immediately after symptom-limited bicycle ergometry.

Results

Inducible myocardial ischemia on perfusion images was detected in 129 patients (49.6%). Baseline NT-proBNP and exercise induced increase in NT-proBNP (ΔNT-proBNP) were significantly higher in patients with myocardial ischemia (median baseline NT-proBNP 155 pg/mL vs 91 pg/mL, P <.001; ΔNT-proBNP 15 pg/mL vs 7 pg/mL, P = .002). Compared with patients in the lowest ΔNT-proBNP quartile, those in the highest quartile of ΔNT-proBNP had three times the risk of inducible ischemia (relative risk, 2.9; 95% confidence interval, 1.4 to 6.0; P = .003). Overall, the accuracy of baseline NT-proBNP and ΔNT-proBNP in the detection of myocardial ischemia were similar to that of the exercise electrocardiogram (ECG). Combining exercise ECG and baseline NT-proBNP or ΔNT-proBNP slightly increased the accuracy of exercise ECG only.

Conclusion

The NT-proBNP level at rest as well as ΔNT-proBNP during exercise stress testing is associated with inducible myocardial ischemia. NT-proBNP levels may have incremental value in the diagnosis of myocardial ischemia.     

急性心肌梗死KillipⅡ级患者经皮冠状动脉介入治疗后血浆脑钠素、心钠素水平的变化

目的研究急性心肌梗死(acutemyocardialinfarction,AMI)伴左心力衰竭患者经皮冠状动脉介入治疗(PCI)后心钠素(atrialnatriureticpeptide,ANP)和脑钠素(brainnatriureticpeptide,BNP)二种因子的变化及其临床意义。方法入选AMIKillipⅡ级患者40例作为试验组,在AMI1周内行PCI治疗,另入选AMIKillipⅡ级未行PCI治疗患者40例作为对照组。试验组患者于AMI48h内,PCI术后24h,术后1个月时,对照组患者在相对应的时间,采集肘静脉血,采用酶联免疫吸附法分析,测血浆ANP及BNP水平。结果两组间ANP、BNP水平比较,试验组患者AMI48h内,血浆ANP、BNP水平均与对照组相似,两者间无显著性差异(P>0.05)。PCI术后24h,术后1个月ANP、BNP水平均较对照组明显降低,两组间有显著性差异(P<0.05);组内比较,试验组患者PCI术后24hANP、BNP水平较AMI48h内减低,但两者间无显著性差异(P>0.05);PCI术后1月ANP、BNP水平较术前明显回落,两者有显著性差异(P<0.05)。对照组患者在相对应的PCI术后24h,术后1个月这一时限ANP、BNP水平较AMI48h内无明显变化(P>0.05)。结论本研究发现AMIKillipⅡ级患者经PCI治疗可使血浆ANP、BNP水平降低。     

Risk prediction in acute coronary syndrome from serial in-hospital measurements of N-terminal pro-B-type natriuretic peptide

There is limited information about the in-hospital plasma profile of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in patients with non-ST-elevation acute coronary syndrome (NSTACS) and furthermore, the prognostic influence of the timing of NT-proBNP measurements in NSTACS is unsettled. These subject matters are elucidated in this study composed of 455 patients with NSTACS (symptoms <24 h). NT-proBNP was measured at 0, 6, 12, 24, 36, 48, 72 and 96 h following admission. Any death was registered at follow-up (median: 2.3 years). The study demonstrated a monophasic profile of the plasma NT-proBNP values, reaching a maximum at 6 hours, and it showed an independent prognostic significance of NT-proBNP irrespective of the sampling time. Risk prediction by NT-proBNP was improved by combining the baseline measurement and one value taken between 24 and 96 h (at 48 h, P<0.001). No additional prognostic information was provided by including more than one late in-hospital NT-proBNP value. Conclusions: The in-hospital NT-proBNP measurements exhibit a monophasic profile in patients with NSTACS and these values provide independent prognostic information as regards mortality irrespective of the sampling time. Moreover, risk prediction of NT-proBNP is strengthened by combining the admission measurement with an additional value during the hospitalization.     

经皮冠状动脉介入治疗对急性心肌梗死患者氨基末端脑钠尿肽原及心功能的影响

目的:研究急性心肌梗死(AMI)患者接受急诊及择期经皮冠状动脉介入治疗（PCI）后血浆氨基末端脑钠尿肽原（NT-proBNP）水平变化及其与心功能的关系。方法: 入选2009年7月~2010年12月,发病后12 h内接受急诊PCI治疗的ST段抬高型心肌梗死（STEMI）患者94例,住院期间未行第2次PCI治疗者为A组（n=46）,住院期间第5~7天行第2次PCI治疗者为B组（n=48）;发病后24 h内入院的AMI患者未行再灌注治疗者为C组（n=34）;使用电化学发光测量不同时间NT-proBNP水平,同时测量心肌梗死后不同时间左室舒张末期直径(LVEDD)、左室收缩末期容积(LVSDV)、左室舒张末期容积(LVEDV)及左室射血分数(LVEF)。结果: A、B两组各时间点NT-proBNP水平较C组明显下降,LVEDD、LVSDV、LVEDV、LVEF在45 d及6个月时较C组明显下降,差异有统计学意义（P<0.05）;同时,B组NT-proBNP水平在45 d及6个月时与A组相比进一步下降,LVEDD、LVSDV、LVEDV、LVEF测量值则进一步改善,两组差异也有统计学意义（P<0.05）。结论: STEMI患者行PCI后NT-proBNP水平有显著下降趋势,且NT-proBNP水平可以作为患者心功能预测因子,后续的择期PCI治疗能进一步降低NT-proBNP及改善心功能。     

Risk prediction in acute coronary syndrome from serial in-hospital measurements of N-terminal pro-B-type natriuretic peptide

There is limited information about the in-hospital plasma profile of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in patients with non-ST-elevation acute coronary syndrome (NSTACS) and furthermore, the prognostic influence of the timing of NT-proBNP measurements in NSTACS is unsettled. These subject matters are elucidated in this study composed of 455 patients with NSTACS (symptoms <24 h). NT-proBNP was measured at 0, 6, 12, 24, 36, 48, 72 and 96 h following admission. Any death was registered at follow-up (median: 2.3 years). The study demonstrated a monophasic profile of the plasma NT-proBNP values, reaching a maximum at 6 hours, and it showed an independent prognostic significance of NT-proBNP irrespective of the sampling time. Risk prediction by NT-proBNP was improved by combining the baseline measurement and one value taken between 24 and 96 h (at 48 h, P<0.001). No additional prognostic information was provided by including more than one late in-hospital NT-proBNP value. Conclusions: The in-hospital NT-proBNP measurements exhibit a monophasic profile in patients with NSTACS and these values provide independent prognostic information as regards mortality irrespective of the sampling time. Moreover, risk prediction of NT-proBNP is strengthened by combining the admission measurement with an additional value during the hospitalization.     

氨基末端脑钠肽前体在急性ST段抬高型心肌梗死急诊PCI术后患者中的临床意义

目的评价急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)术后血浆氨基末端脑钠肽前体(NT-proBNP)水平的临床意义。方法选择207例发病24 h之内进行急诊PCI的STEMI患者,采用荧光免疫抗原抗体结合方法测定术后入院即时血浆NT-proBNP水平,收集年龄、左室射血分数(LVEF)、入院时心功能(killip分级)、发病至梗死相关血管开通时间等临床资料,并根据相应程度或等级分组,对比各组间NT-proBNP水平的差异。结果 NT-proBNP水平与年龄呈正相关(r=0.39,P=0.000),与LVEF呈负相关(r=-0.29,P=0.000);入院时killip分级Ⅲ～Ⅳ级组和Ⅱ级组NT-proBNP水平高于I级组(P均<0.01);随着STEMI患者梗死相关血管开通时间的延迟,NT-proBNP水平依次增高(P均<0.01)。结论 STEMI患者PCI术后血浆NT-proBNP水平与年龄、LVEF、killip分级、发病至梗死相关血管开通时间相关。     

Plasma N-terminal pro-B-type natriuretic peptide and mortality in type 2 diabetes

Aims/hypothesis Raised N-terminal pro-B-type natriuretic peptide (NT-proBNP) is associated with a poor cardiac outcome in non-diabetic populations. Elevated NT-proBNP predicts excess morbidity and mortality in diabetic patients with an elevated urinary albumin excretion rate. This study investigated the prognostic value of NT-proBNP in a cohort of type 2 diabetic patients. Subjects, materials and methods In a prospective observational follow-up study, 315 type 2 diabetic patients with normoalbuminuria (n=188), microalbuminuria (n=80) and macroalbuminuria (n=47) at baseline were followed for a median (range) of 15.5 (0.2–17.0) years. Plasma NT-proBNP concentrations were determined by immunoassay at baseline. Endpoints were overall and cardiovascular mortality. Results Of the patients, 162 died (51%), 119 of them (74%) due to cardiovascular causes. All-cause mortality was increased in patients with NT-proBNP in the second and third tertiles (hazard ratios [95% CI] compared with the first tertile, 1.70 [1.08–2.67] and 5.19 [3.43–7.88], p<0.001). These associations persisted after adjustment for urinary albumin excretion rate, glomerular filtration rate and conventional cardiovascular risk factors (covariate adjusted hazard ratios 1.46 [0.91–2.33] and 2.54 [1.56–4.14], p<0.001). This increased mortality was attributable to more cardiovascular deaths in the second and third NT-proBNP tertile (unadjusted hazard ratios 1.63 [0.96–2.77] and 4.88 [3.01–7.91], p<0.001; covariate adjusted 1.37 [0.79–2.37] and 2.26 [1.27–4.02], p=0.01). When patients with normo-, micro- and macroalbuminuria were analysed separately, NT-proBNP levels above the median (62 ng/l) were consistently associated with increased overall and cardiovascular mortality in all three groups (p<0.001). Conclusions/interpretation In patients with type 2 diabetes, elevated circulating NT-proBNP is a strong predictor of the excess overall and cardiovascular mortality, this predictor status being independent of urinary albumin excretion rate and conventional cardiovascular risk factors.     

The effect of percutaneous coronary revascularization on plasma N-terminal pro-B-type natriuretic peptide levels in stable coronary artery disease

BackgroundThis study was conducted to assess the effect of percutaneous coronary revascularization (PCR) on plasma NT-proBNP concentration in patients with chronic stable angina (CSA).MethodsThis prospective open label interventional study included 22 patients with moderate to severe CSA, normal left ventricular (LV) systolic functions and critical (>90%) proximal stenosis in one of the three major epicardial coronary arteries. After stabilization of medications for 8 weeks, resting supine plasma NT-proBNP levels were measured and patients underwent PCR of the involved vessels. Eight weeks later, with medications unaltered; plasma NT-proBNP levels were repeated and compared with the baseline levels. LV systolic and diastolic functions were assessed before and after PCR.ResultsThe mean age of the patients was 61.27 ± 8.87 years. Out of 22 patients, 20 were male and 2 were female. PCR was performed on left anterior descending coronary artery (LAD) in 12 patients and in a non-LAD vessel in 10 patients. After 8 weeks of successful PCR, there was a significant overall reduction in mean plasma NT-proBNP levels (from 244.36 ± 218.99 to 168.68 ± 161.61 pg/mL, p = 0.016). The patients who underwent PCR of LAD demonstrated significantly reduced NT-pro-BNP levels after PCR (p = 0.009). In the non-LAD group, NT-proBNP levels also decreased, albeit insignificantly (p = 0.432). Reduction in NT-proBNP was independent of change in LV systolic functions.ConclusionSuccessful PCR, by relieving myocardial ischemia, significantly reduced plasma NT-proBNP levels in majority of the patients with chronic stable angina secondary to critical epicardial coronary artery stenosis.     

无器质性心脏病者血浆N末端B型利钠肽原浓度及其影响因素

Objective To determine the reference value of plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) in subjects without heart diseases. Methods The plasma concentration of NT-proBNP was measured with ELISA method in 300 adults excluded heart disease through various examinations including electrocardiography, echocardiography, X-ray and coronary artery angiography. The plasma NT-proBNP concentration was compared between age-groups 30-39, 40-49, 50-59, 60-69 and ≥70 years old, between male and female in the same age-group and between subjects with and without hypertension, diabetes and obesity. A multiple linear regression analysis was used to detect factors influencing NT-proBNP among age, sex, body mass index, blood pressure, heart rate, serum creafinine, hypertension, diabetes mellitus, use of angiotensin-converting-enzyme inhibitors, Ca2+ -antagonist, and β-blocker. Results The plasma NT-proBNP concentration increased in proportion to aging in male subjects more than 60 years old (P < 0.05), remained unchanged in males less than 60 years old and females (P > 0.05 ). Plasma NT-proBNP concentration was significantly higher in female (170-660 pmol/L) than in male (160-470 pmol/L) in subjects less than 60 years old (P<0.05) and significantly lower in female (180-560 pmol/L) than in male (180-760 pmol/L) in subjects more than 60 years old (P < 0.05). Multiple linear regression analysis demonstrated that age was the only independent predictor for plasma NT-proBNP in these subjects (P < 0.01). Conclusion The plasma concentration of NT-proBNP in subjects without heart diseases was different between male and female, and was increasing with age in male subjects more than 60 years old.     

B-type natriuretic peptide and N-terminal pro-B-type natriuretic peptide - Diagnostic role in stable coronary artery disease

B-type natriuretic peptide (BNP) and its N-terminal fragment (NT-proBNP) are released from ventricular cardiomyocytes in response to an increase in ventricular wall stress and to myocardial ischemia. Both BNP and NT-proBNP have proven to be reliable diagnostic and prognostic biomarkers in patients with heart failure. Recently, the diagnostic roles of BNP and NT-proBNP in patients with coronary artery disease (CAD) have been investigated. For patients with acute coronary syndromes, data have been derived from a great number of studies, whereas in patients with stable CAD, only a limited amount of recent data is available; although limited, these data show that elevations in BNP and NT-proBNP levels are associated with the extent of CAD, thus providing prognostic information for an unfavourable clinical outcome. However, clinical and therapeutic implications are indistinct and need to be elucidated in further studies.     

无器质性心脏病者血浆N末端B型利钠肽原浓度及其影响因素

目的 探讨成年人血浆N末端B型利钠肽原(NT-proBNP)的正常参考值范围及影响因素.方法 选择常规临床检查和冠状动脉造影正常的成年人300例,用酶联免疫吸附法检测血浆NT-proBNP浓度.以每10岁为一个年龄组,比较各年龄组间和相同年龄组的男女间血浆NT-proBNP浓度的差异,并分别比较有与无高血压病、糖尿病及超重者的血浆NT-proBNP浓度.用多元逐步回归分析方法,分析血浆NT-proBNP浓度的影响因素.并计算血浆NT-proBNP浓度的正常参考值.结果 在正常成年人,血浆NT-proBNP浓度在男性60岁以上者随年龄升高而升高(P<0.05),而在男性60岁以下者和女性则不随年龄变化而变化(均P>0.05).男女间比较,血浆NT-proBNP浓度在60岁以下女性高于男性(P<0.05),而60岁以上则男性高于女性(P<0.05).有与无高血压病、糖尿病及超重者间分别比较血浆NT-proBNP浓度均无统计学差异(均P>0.05).多元逐步回归分析表明,年龄是血浆NT-proBNP浓度的独立预测因素(P<0.01).血浆NT-proBNP浓度的正常参考值范围在60岁以下男女分别为160～470 pmol/L和170～660 pmol/L,60岁以上男女分别为180～760pmol/L和180～560 pmol/L,总体为160～600 pmol/L.结论 在无器质性心脏病并且肾功能正常的成年人,血浆NT-proBNP浓度有性别差异,并在60岁以上男性随年龄增长而增加.