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)