Navarro Estrada José Luis, Rubinstein Fernando, Bahit Maria Cecilia, Rolandi Florencia, Perez de Arenaza Diego, Gabay Jose M, Alvarez Jose, Sarmiento Ricardo, Rojas Matas Carlos, Sztejfman Carlos, Tettamanzi Alejandro, de Miguel Raul, Guzman Luis
Hospital Italiano de Buenos Aires, Ciudad de Buenos Aires, Buenos Aires, Argentina.
Am Heart J. 2006 May;151(5):1093.e1-7. doi: 10.1016/j.ahj.2005.12.020.
NT-probrain natriuretic peptide (NT-proBNP) has been associated with left ventricular (LV) dysfunction and adverse outcome in patients with non-ST-elevation acute coronary syndromes (NSTEACS). However, the underlying pathophysiological mechanisms responsible for this association have not been well established. We sought to explore the relation between NT-proBNP levels and extension of coronary artery disease (CAD) and the presence of more complex and severe coronary lesions.
This prospective, multicenter angiographic substudy included 585 patients admitted with NSTEACS. Blinded measurements of NT-proBNP and troponin T were performed at a median time of 3 hours after admission and analyzed centrally. Angiograms were read at a core laboratory by 2 independent readers blinded to patient data. Complex coronary lesion was defined as the presence of at least one of the following: thrombus (+), TIMI flow < 2, or ulcerated plaque.
NT-probrain natriuretic peptide levels increased proportionally as LV function decreased. The levels of NT-proBNP were directly related to the extent of the CAD. This association was maintained when we analyzed patients with normal LV function (n = 257). Patients with complex coronary lesions or those with at least one of its individual component had higher levels of NT-proBNP compared with those without complex coronary lesions. After adjusting for clinical and electrocardiographic variables and other biomarkers, positive troponin (OR 2.20, 95% CI 1.50-3.22, P < .0001) and supramedian NT-proBNP levels (OR 1.72, 95% CI 1.19-2.47, P = .003) independently contributed to the prediction of complex coronary lesions.
In this study of patients with NSTEACS, NT-proBNP levels progressively increase with the severity of CAD and degree of LV dysfunction. Increased levels of NT-proBNP independently predict the presence of more complex coronary lesions.
N端前脑钠肽（NT-proBNP）与非ST段抬高型急性冠状动脉综合征（NSTEACS）患者的左心室（LV）功能障碍及不良预后相关。然而，导致这种关联的潜在病理生理机制尚未完全明确。我们旨在探讨NT-proBNP水平与冠状动脉疾病（CAD）范围以及更复杂、严重冠状动脉病变存在之间的关系。
这项前瞻性、多中心血管造影亚研究纳入了585例因NSTEACS入院的患者。在入院后中位时间3小时进行NT-proBNP和肌钙蛋白T的盲法测量，并进行集中分析。血管造影图像由核心实验室的2名独立阅片者在对患者数据不知情的情况下进行解读。复杂冠状动脉病变定义为存在以下至少一项：血栓（+）、TIMI血流<2或溃疡斑块。
NT-proBNP水平随左心室功能下降成比例升高。NT-proBNP水平与CAD范围直接相关。在分析左心室功能正常的患者（n = 257）时，这种关联依然存在。与无复杂冠状动脉病变的患者相比，有复杂冠状动脉病变或至少有其单个组成部分之一的患者NT-proBNP水平更高。在调整临床、心电图变量及其他生物标志物后，肌钙蛋白阳性（OR 2.20，9% CI 1.50 - 3.22，P <.0001）和NT-proBNP水平高于中位数（OR 1.72，95% CI 1.19 - 2.47，P =.003）独立有助于预测复杂冠状动脉病变。
在这项针对NSTEACS患者的研究中，NT-proBNP水平随CAD严重程度和左心室功能障碍程度逐渐升高。NT-proBNP水平升高独立预测更复杂冠状动脉病变的存在。
