长期使用β-肾上腺素能受体阻滞剂治疗的急性心肌梗死患者中，N端前B型利钠肽在风险分层中的作用

N-terminal pro-B-type natriuretic peptide in risk stratification after acute myocardial infarction in patients on long-term beta-adrenergic receptor blocker therapy.

作者信息

Jonsson Gisli, Abdelnoor Michael, Landaas Sverre, Muller Carl, Kjeldsen Sverre Erik, Os Ingrid, Westheim Arne

机构信息

Department of Cardiology,Ullevaal University Hospital, Oslo, Norway.

出版信息

Cardiology. 2006;106(2):102-8. doi: 10.1159/000092743. Epub 2006 Apr 21.

DOI:10.1159/000092743

PMID:16636540

Abstract

BACKGROUND

N-terminal pro-B-type natriuretic peptide (NT-proBNP) appears to be a strong risk marker of mortality in patients with acute coronary syndrome. However, little information is available on NT-proBNP as a predictor of long-term serious cardiovascular events beyond that of left ventricular ejection fraction in patients with acute myocardial infarction (AMI), most of them treated with an early invasive strategy and on a uniform optimal secondary preventive medication including long-term beta-adrenergic receptor blockade.

OBJECTIVE

To assess the prognostic impact of plasma NT-proBNP in patients with AMI who received optimal medical treatment including long-term beta-adrenergic receptor blockade.

METHODS

Plasma NT-proBNP was measured in 219 patients (age range 31-80 years) with AMI at baseline, and then followed for a median duration of 1.63 years. The first occurrences of a serious cardiovascular event including cardiac mortality, nonfatal MI, and congestive heart failure were registered.

RESULTS

Ninety serious cardiovascular events occurred. Left ventricular ejection fraction and reperfusion therapy with thrombolysis or percutaneous coronary intervention were identified as confounders. When adjusting for these factors in multivariate analysis, NT-proBNP was a strong predictor of serious cardiovascular events in patients with a plasma NT-proBNP of >162.2 pmol/l and aged <60 years (p = 0.001). The incidence rate was related to increasing NT-proBNP (p = 0.0017). The risk of serious cardiovascular events was higher in patients with NT-proBNP levels in the highest quartile (> or =162.2 pmol/l) than in those with levels in the three lowest quartiles (rate ratio = 2.5, 95% confidence interval = 1.6-3.9, p = 0.0001).

CONCLUSION

AMI patients with high plasma NT-proBNP seem to be at an increased risk of serious cardiovascular events, but only those < or =60 years of age.

摘要

背景

N 末端 B 型利钠肽原（NT-proBNP）似乎是急性冠状动脉综合征患者死亡率的一个强有力的风险标志物。然而，关于 NT-proBNP 作为急性心肌梗死（AMI）患者左心室射血分数之外的长期严重心血管事件预测指标的信息很少，其中大多数患者接受早期侵入性策略治疗，并采用统一的最佳二级预防药物，包括长期β-肾上腺素能受体阻滞剂。

目的

评估血浆 NT-proBNP 对接受包括长期β-肾上腺素能受体阻滞剂在内的最佳药物治疗的 AMI 患者的预后影响。

方法

对 219 例年龄在 31 - 80 岁的 AMI 患者在基线时测定血浆 NT-proBNP，然后随访中位时间 1.63 年。记录首次发生的严重心血管事件，包括心源性死亡、非致命性心肌梗死和充血性心力衰竭。

结果

发生了 90 例严重心血管事件。左心室射血分数以及溶栓或经皮冠状动脉介入再灌注治疗被确定为混杂因素。在多变量分析中对这些因素进行校正后，血浆 NT-proBNP >162.2 pmol/l 且年龄<60 岁的患者中，NT-proBNP 是严重心血管事件的强有力预测指标（p = 0.001）。发病率与 NT-proBNP 升高相关（p = 0.0017）。NT-proBNP 水平处于最高四分位数（≥162.2 pmol/l）的患者发生严重心血管事件的风险高于处于三个最低四分位数的患者（率比 = 2.5，95%置信区间 = 1.6 - 3.9，p = 0.0001）。