Oduncu Vecih, Erkol Ayhan, Tanalp Ali Cevat, Dündar Cihan, Tanboğa Ibrahim Halil, Sırma Dicle, Karagöz Ali, Karabay Can Yücel, Izgi Akın, Pala Selçuk, Tigen Kürşat, Kırma Cevat
Department of Cardiology, Kartal Koşuyolu Heart and Research Hospital, İstanbul, Turkey.
Turk Kardiyol Dern Ars. 2011 Oct;39(7):540-8. doi: 10.5543/tkda.2011.01610.
We assessed in-hospital prognostic value of admission plasma B-type natriuretic peptide (BNP) levels in patients undergoing primary percutaneous coronary intervention (p-PCI) for acute ST-elevation myocardial infarction (STEMI).
In a retrospective design, we evaluated 992 patients (801 males, 191 females; mean age 56 ± 12 years) treated with p-PCI for STEMI. The patients were divided into two groups according to the admission BNP levels, taking the cut-off value of BNP as 100 pg/ml; i.e, ≥ 100 pg/ml (n=334, 33.7%) and <100 pg/ml (n=658, 66.3%). Postprocedural angiographic and clinical in-hospital results were recorded.
No-reflow (24% vs. 9%), heart failure (32.3% vs. 5.5%) and death (15.6% vs. 1.7%) were significantly more common in patients with BNP ≥ 100 pg/ml (p<0.001). In multivariate analysis, elevated baseline BNP level was identified as an independent predictor of no-reflow (OR=1.83; 95% CI 1.22-2.74, p=0.003), acute heart failure (OR=2.67; 95% CI 1.55-4.58, p<0.001), and in-hospital mortality (OR=3.28; 95% CI 1.51-7.14, p=0.003). In receiver operating characteristic curve analysis, the area under the curve and sensitivity/specificity of the cut-off value of BNP (100 pg/ml) for prediction of clinical endpoints were 0.741 and 58.6%/70.3% for no-reflow, 0.822 and 75%/73.3% for heart failure, and 0.833 and 82.5%/69.4% for death, respectively (p<0.001 for all).
Elevated admission BNP level is an independent predictor of angiographic no-reflow, acute heart failure, and mortality in STEMI patients during in-hospital period, suggesting that it might be incorporated into traditional risk scoring systems to improve early risk stratification.
我们评估了急性ST段抬高型心肌梗死（STEMI）患者接受直接经皮冠状动脉介入治疗（p-PCI）时入院血浆B型利钠肽（BNP）水平的院内预后价值。
在一项回顾性研究中，我们评估了992例接受p-PCI治疗的STEMI患者（801例男性，191例女性；平均年龄56±12岁）。根据入院时BNP水平将患者分为两组，将BNP的临界值设定为100 pg/ml；即≥100 pg/ml（n = 334，33.7%）和<100 pg/ml（n = 658，66.3%）。记录术后血管造影和院内临床结果。
BNP≥100 pg/ml的患者中无复流（24%对9%）、心力衰竭（32.3%对5.5%）和死亡（15.6%对1.7%）明显更为常见（p<0.001）。在多变量分析中，基线BNP水平升高被确定为无复流（OR = 1.83；95%CI 1.22 - 2.74，p = 0.003）、急性心力衰竭（OR = 2.67；95%CI 1.55 - 4.58，p<0.001）和院内死亡率（OR = 3.28；95%CI 1.51 - 7.14，p = 0.003）的独立预测因素。在受试者工作特征曲线分析中，BNP临界值（100 pg/ml）预测临床终点的曲线下面积及敏感度/特异度分别为：无复流时为0.741和58.6%/70.3%，心力衰竭时为0.822和75%/73.3%，死亡时为0.833和82.5%/69.4%（均p<0.001）。
入院时BNP水平升高是STEMI患者院内血管造影无复流、急性心力衰竭和死亡率的独立预测因素，提示其可能被纳入传统风险评分系统以改善早期风险分层。
