N末端脑钠肽前体是充血性心力衰竭的生物标志物，可预测接受直接经皮冠状动脉介入治疗的急性心肌梗死患者30天内的不良临床结局。

N-terminal pro-brain natriuretic peptide is a biomarker of congestive heart failure and predictive of 30-day untoward clinical outcomes in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention.

作者信息

Wu Chiung-Jen, Chang Hsueh-Wen, Hung Wei-Chin, Yang Cheng-Hsu, Chen Yen-Hsun, Su Cheng-Yur, Yip Hon-Kan

机构信息

Division of Cardiology, Chang Gung Memorial Hospital, Kaohsiung, 123 Ta-Pei Road, Niao Sung Hsiang, Kaohsiung Hsien 83301, Taiwan, ROC.

出版信息

Circ J. 2006 Feb;70(2):163-8. doi: 10.1253/circj.70.163.

DOI:10.1253/circj.70.163

PMID:16434809

Abstract

BACKGROUND

Increased levels of N-terminal pro-brain natiuretic peptide (NT-proBNP) are now recognized as a new and useful biochemical marker that is predictive of clinical outcomes in patients with congestive heart failure (CHF). However, an association between an increased circulating level of this biomarker and clinical outcomes in patients following acute myocardial infarction (AMI) has not been fully delineated. Thus, the purpose of this study was to test whether NT-proBNP can predict prognosis in patients following ST-segment elevated AMI.

METHODS AND RESULTS

A prospective cohort study of 242 consecutive patients with ST-segment elevated AMI of onset <12 h who underwent primary percutaneous coronary intervention (PCI) was conducted. Blood samples for plasma concentration of NT-proBNP were collected following vascular puncture. Univariate analysis demonstrated that the 30-day composite major adverse clinical outcomes (MACO) [advanced Killip score > or =3, functional class > or =3 of CHF and 30-day mortality] were strongly associated with elevated NT-proBNP (>243 pg/ml) (p<0.0001), unsuccessful reperfusion (final thrombolysis in myocardial infarction flow < or =2) (p<0.0001), left ventricular ejection fraction (LVEF) <45% (p<0.0001), diabetes mellitus (DM) (p=0.0004) and multivessel disease (p=0.0005). Multiple stepwise logistic regression analysis demonstrated that elevation of NT-proBNP (p=0.0002), LVEF < 45% (p=0.0003), DM (p=0.0007), unsuccessful reperfusion (p=0.006), and age (> or =70 years) (p=0.031) are independent predictors of 30-day MACO. Additionally, elevation of NT-proBNP, together with advanced Killip score and unsuccessful reperfusion, are significant independent predictors of increased 30-day mortality (all p values <0.005).

CONCLUSION

Increased NT-proBNP level was the most independent predictor of 30-day MACO in patients with ST-segment elevated AMI undergoing primary PCI.

摘要

背景

N 末端脑钠肽前体（NT-proBNP）水平升高现已被公认为一种新的、有用的生化标志物，可预测充血性心力衰竭（CHF）患者的临床结局。然而，这种生物标志物循环水平升高与急性心肌梗死（AMI）患者临床结局之间的关联尚未完全阐明。因此，本研究的目的是检验 NT-proBNP 是否能预测 ST 段抬高型 AMI 患者的预后。

方法与结果

对 242 例连续的发病时间<12 小时且接受直接经皮冠状动脉介入治疗（PCI）的 ST 段抬高型 AMI 患者进行了一项前瞻性队列研究。血管穿刺后采集血样检测血浆 NT-proBNP 浓度。单因素分析表明，30 天综合主要不良临床结局（MACO）[高级 Killip 评分≥3、CHF 功能分级≥3 以及 30 天死亡率]与 NT-proBNP 升高（>243 pg/ml）（p<0.0001）、再灌注未成功（最终心肌梗死溶栓血流≤2）（p<0.0001）、左心室射血分数（LVEF）<45%（p<0.0001）、糖尿病（DM）（p= .0004）和多支血管病变（p=0.0005）密切相关。多步逻辑回归分析表明，NT-proBNP 升高（p=0.0002）、LVEF<45%（p=0.0003）、DM（p=0.0007）、再灌注未成功（p=0.006）以及年龄（≥70 岁）（p=0.031）是 30 天 MACO 的独立预测因素。此外，NT-proBNP 升高，连同高级 Killip 评分和再灌注未成功，是 30 天死亡率增加的显著独立预测因素（所有 p 值<0.005）。