Department of Cardiology, Medical University of Bialystok, Bialystok, Poland.
Kardiol Pol. 2011;69(10):1008-14.
In patients with acute myocardial infarction (AMI), B-type natriuretic peptide (BNP) is a predictor of short- and medium-term mortality.
To evaluate the long-term prognostic value of a single measurement of plasma BNP in low risk patients with first ST-elevation myocardial infarction (STEMI).
Plasma BNP concentrations were analysed on admission in 211 patients, median age 68 (56.0-75.0) years, admitted with first STEMI and treated with primary percutaneous coronary intervention (PPCI). Left ventricular ejection fraction (LVEF) was assessed by echocardiography during the first 24 h. Patients were followed for a median 48.2 (42.3-72.6) months.
The median BNP level was 92.5 (36.3-199.2) pg/mL. During the follow-up period, 79.6% of patients survived. Logistic regression analysis indicated that among the assessed clinical, biochemical, angiographic and echocardiographic parameters, the best predictors of mortality were age, LVEF, maximal creatinine concentration and BNP measurements, (p < 0.05). In multivariate Cox regression analysis for the prediction of death, only age remained significant (p = 0.00007). Admission BNP level > 400 pg/mL indicated patients with the highest risk of death (47.1% vs 22% and 18.4% in patients with BNP level < 100 pg/mL and 100-400 pg/mL, respectively; p < 0.05).
A single measurement of BNP on admission can improve long-term risk stratification in low risk first STEMI patients treated with PPCI.
在急性心肌梗死（AMI）患者中，B 型利钠肽（BNP）是短期和中期死亡率的预测指标。
评估初次 ST 段抬高型心肌梗死（STEMI）低危患者单次测量血浆 BNP 的长期预后价值。
对 211 例初次接受经皮冠状动脉介入治疗（PPCI）的初次 STEMI 患者入院时的血浆 BNP 浓度进行分析，中位年龄 68（56.0-75.0）岁。在首次 24 小时内行超声心动图评估左心室射血分数（LVEF）。中位随访时间为 48.2（42.3-72.6）个月。
中位 BNP 水平为 92.5（36.3-199.2）pg/ml。在随访期间，79.6%的患者存活。Logistic 回归分析表明，在所评估的临床、生化、血管造影和超声心动图参数中，死亡率的最佳预测因素是年龄、LVEF、最大肌酐浓度和 BNP 测量值（p < 0.05）。多变量 Cox 回归分析预测死亡，只有年龄具有统计学意义（p = 0.00007）。入院时 BNP 水平 > 400pg/ml 表明患者死亡风险最高（47.1%比 BNP 水平 < 100pg/ml 和 100-400pg/ml 的患者分别为 22%和 18.4%；p < 0.05）。
在接受 PPCI 治疗的初次 STEMI 低危患者中，单次入院 BNP 测量可改善长期风险分层。
