N末端B型利钠肽原与接受直接经皮冠状动脉介入治疗的急性ST段抬高型心肌梗死患者的不良短期临床结局相关。
N-terminal pro-B-type natriuretic peptide is associated with adverse short-term clinical outcomes in patients with acute ST-elevation myocardial infarction underwent primary percutaneous coronary intervention.
作者信息
Kwon Taek Geun, Bae Jang Ho, Jeong Myung Ho, Kim Young Jo, Hur Seung Ho, Seong In Whan, Cho Myeong Chan, Seung Ki Bae, Jang Yang Soo, Park Seung Jung
机构信息
Cardiology, Heart Center, Konyang University Hospital, Deajeon, South Korea.
出版信息
Int J Cardiol. 2009 Apr 3;133(2):173-8. doi: 10.1016/j.ijcard.2007.12.022. Epub 2008 Feb 20.
BACKGROUND
Increased level of N-terminal pro-B type natriuretic peptide (NT-proBNP) is known to be associated with adverse outcome in patients with acute coronary syndrome. We evaluated early outcomes of patients with acute ST-elevated myocardial infarction (STEMI) according to the level of NT-proBNP as a substudy of Korean Acute Myocardial Infarction Registry (KAMIR).
METHODS
Study population consisted of 1052 consecutive patients (mean 61.3+/-12.8 years old, male 73.2%) with STEMI of onset <12 h who underwent primary percutaneous coronary intervention (PCI) and who had baseline NT-proBNP level by electrochemiluminescence immnunoassay (ECLIA, NT-proBNP kit, Roche Diagnostics, Mannheim, Germany). The study subjects were divided into two groups according to the level of serum NT-proBNP.
RESULTS
Patients with NT-proBNP level >991 pg/mL (n=329, 57.1% male) had lower left ventricle ejection fraction (LVEF) (47.8+/-11.8% vs. 53.0+/-10.8%, p<0.001), needed longer intensive care (3.7+/-3.6 days vs. 2.8+/-2.4 days, p<0.001) and had higher in-hospital mortality (1.3% vs. 7.4%, p<0.001) than those with NT-proBNP level<or=991 pg/mL (n=723, 80.5% male). Multiple logistic regression analysis revealed that the independent predictors of in-hospital mortality were LVEF<45% (OR 5.43, 95% CI 1.71 to 17.29, p=0.004), elevated NT-proBNP (>991 pg/mL) (OR 3.70, 95% CI 1.14 to 12.03, p=0.030), old age (>or=70 years) (OR 4.71, 95% CI 1.43 to 15.52, p=0.011), advanced Killip class (>1) (OR 4.96, 95% CI 1.58 to 15.53, p=0.006), male gender (OR 5.67, 95% CI 1.45 to 22.21, p=0.013) and TIMI flow 0 before PCI (OR 5.04, 95% CI 1.08 to 23.41, p=0.039).
CONCLUSIONS
This study suggests that baseline NT-proBNP level is associated with short term mortality in patients with STEMI underwent primary PCI.
背景
已知N末端B型利钠肽原（NT-proBNP）水平升高与急性冠脉综合征患者的不良预后相关。作为韩国急性心肌梗死注册研究（KAMIR）的一项子研究，我们根据NT-proBNP水平评估了急性ST段抬高型心肌梗死（STEMI）患者的早期预后。
方法
研究人群包括1052例连续的STEMI患者（平均年龄61.3±12.8岁，男性占73.2%），发病时间<12小时，接受了直接经皮冠状动脉介入治疗（PCI），且通过电化学发光免疫分析（ECLIA，NT-proBNP检测试剂盒，德国曼海姆罗氏诊断公司）检测了基线NT-proBNP水平。研究对象根据血清NT-proBNP水平分为两组。
结果
NT-proBNP水平>991 pg/mL的患者（n = 329，男性占57.1%）的左心室射血分数（LVEF）较低（47.8±11.8%对53.0±10.8%，p<0.001），需要更长时间的重症监护（3.7±3.6天对2.8±2.4天，p<0.001），且院内死亡率更高（1.3%对7.4%，p<0.001），而NT-proBNP水平≤991 pg/mL的患者（n = 723，男性占80.5%）则不然。多因素逻辑回归分析显示，院内死亡的独立预测因素为LVEF<45%（比值比5.43，95%置信区间1.71至17.29，p = 0.004）、NT-proBNP升高（>991 pg/mL）（比值比3.70，95%置信区间1.14至12.03，p = 0.030）、老年（≥70岁）（比值比4.71，95%置信区间1.43至15.52，p = 0.011）、Killip分级较高（>1）（比值比4.96，95%置信区间1.58至15.53，p = 0.006）、男性（比值比5.67，95%置信区间1.45至22.21，p = 0.013）以及PCI前TIMI血流0级（比值比5.04，95%置信区间1.08至23.41，p = 0.039）。
结论
本研究表明，基线NT-proBNP水平与接受直接PCI的STEMI患者的短期死亡率相关。
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