Plasma B-type natriuretic peptide level can predict myocardial tissue perfusion in patients undergoing primary percutaneous coronary intervention for acute ST-segment elevation myocardial infarction.
ABSTRACT Inadequate myocardial tissue perfusion after successful revascularization in ST-segment elevation myocardial infarction (STEMI) is associated with worse clinical outcomes. We investigated whether the plasma B-type natriuretic peptide (BNP) level on admission could predict the status of myocardial tissue perfusion in patients who underwent primary percutaneous coronary intervention (PCI).
The study prospectively enrolled 102 patients with STEMI who underwent primary PCI within 12 h of symptom onset. The grade of myocardial tissue perfusion was measured by ST-segment resolution, corrected thrombolysis in myocardial infarction frame count, and myocardial blush grade after primary PCI. All-cause mortality at 1 month after PCI was assessed.
All patients were divided into two groups according to the BNP level; high-BNP group (≥80 pg/ml, n=43) and low-BNP group (<80 pg/ml, n=59). High-BNP group had significantly lower ST-segment resolution (42.69 ± 24.85 vs. 71.15 ± 19.37%, P<0.001), higher corrected thrombolysis in myocardial infarction frame count (53.7 ± 19.7 vs. 44.5 ± 15.5, P=0.04), lower myocardial blush grade (2.4 ± 0.9 vs. 2.9 ± 0.3, P=0.001), and higher short-term mortality (16.2 vs. 3.3%, P=0.023). In multivariate logistic regression analysis for prediction of good myocardial tissue perfusion after PCI, the odds ratio of low-BNP group was 4.12 (95% confidence interval 1.49-13.08, P<0.01).
The patients with STEMI who had higher BNP level on admission showed inadequate myocardial tissue perfusion status after primary PCI. The plasma BNP level on admission may serve as a predictor of tissue perfusion after primary PCI in patients with STEMI.
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ABSTRACT: N-terminal segment of B-type natriuretic peptide prohormone (NT-proBNP) is elevated in patients with acute myocardial infarction (AMI) thus providing both diagnostic information and prognostic information. The aim of the present study was to determine the time course of NT-proBNP release in patients undergoing transcoronary ablation of septal hypertrophy (TASH) a procedure mimicking AMI. We analyzed the release kinetics of NT-proBNP in 18 consecutive patients with hypertrophic obstructive cardiomyopathy undergoing TASH. Serum samples were collected prior to and at 15, 30, 45, 60, 75, 90, and 105min, and 2, 4, 8, and 24h after TASH. NT-proBNP concentrations showed a continuous increase during the first 75min with a significant percent change compared to baseline value already 15min after TASH (105.6% [IQR 102.2-112.7]; P<0.001). All patients had a significant increase of NT-proBNP at 45min (range of percent increase [min-max]: 103.5-137.2%; range of absolute increase [min-max]: 23.5-304.0ng/L). NT-proBNP concentrations decreased below the baseline value until the 8th h after initiation of myocardial infarction. NT-proBNP concentration increases immediately after induction of myocardial infarction proving early evidence of myocardial injury despite the decrease of the left ventricular wall stress due to the TASH related reduction of the left ventricular outflow gradient.Clinica chimica acta; international journal of clinical chemistry 11/2013; · 2.54 Impact Factor