Akgul O, Uyarel H, Pusuroglu H, Isiksacan N, Turen S, Erturk M, Surgit O, Celik O, Oner E, Birant A, Akturk I F, Uslu N
Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Kucukcekmece, Istanbul
Herz. 2014 Jun;39(4):507-14. doi: 10.1007/s00059-013-3853-8.
The aim of this study was to evaluate the predictive value of brain natriuretic peptide (BNP) in the development of acute kidney injury (AKI) and 6-month all-cause mortality after primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) in a modest-risk population.
The prognostic value of BNP has been well documented in patients with acute coronary syndrome. However, its value in development of AKI and 6-month all-cause mortality in patients with STEMI undergoing primary PCI remains unclear.
We prospectively enrolled 424 consecutive STEMI patients (mean age 53.6 ± 12.1 years) undergoing primary PCI. The population was divided into two groups: a high (n = 110) and a low (n = 314) admission BNP group according to the cut-off value (> 88.7 pg/ml) determined by ROC analysis to have the best predictive accuracy for 6-month all-cause mortality. The clinical characteristics as well as the in-hospital and 6-month outcomes of patients undergoing primary PCI were analyzed.
Cox multivariate analysis showed that a high-admission BNP value (> 88.7 pg/ml) was an independent predictor of AKI development (odds ratio, 1.002; 95 % confidence interval, 1.000–1.003; p = 0.02) and 6-month all-cause mortality (odds ratio, 1.003; 95 % confidence interval; 1.001–1.004; p = 0.004).
These results suggest that a high-admission BNP level is associated with an increased risk of AKI development and 6-month all-cause mortality in patients with STEMI undergoing primary PCI.
本研究旨在评估脑钠肽（BNP）对中度风险人群ST段抬高型心肌梗死（STEMI）患者在接受直接经皮冠状动脉介入治疗（PCI）后发生急性肾损伤（AKI）及6个月全因死亡率的预测价值。
BNP的预后价值在急性冠状动脉综合征患者中已有充分记录。然而，其在接受直接PCI的STEMI患者发生AKI及6个月全因死亡率方面的价值仍不明确。
我们前瞻性纳入了424例连续接受直接PCI的STEMI患者（平均年龄53.6±12.1岁）。根据通过ROC分析确定的对6个月全因死亡率具有最佳预测准确性的临界值（>88.7 pg/ml），将人群分为两组：高入院BNP组（n = 110）和低入院BNP组（n = 314）。分析了接受直接PCI患者的临床特征以及住院期间和6个月的结局。
Cox多变量分析显示，高入院BNP值（>88.7 pg/ml）是AKI发生（比值比，1.002；95%置信区间，1.000 - 1.003；p = 0.02）和6个月全因死亡率（比值比，1.003；95%置信区间；1.001 - 1.004；p = 0.004）的独立预测因素。
这些结果表明，高入院BNP水平与接受直接PCI的STEMI患者发生AKI及6个月全因死亡率风险增加相关。
