Radosavljevic-Radovanovic Mina, Radovanovic Nebojsa, Vasiljevic Zorana, Marinkovic Jelena, Mitrovic Predrag, Mrdovic Igor, Stankovic Sanja, Kružliak Peter, Beleslin Branko, Uscumlic Ana, Kostic Jelena
Cardiology Clinic, Clinical Center of Serbia and Medical School, University of Belgrade.
Institute of Statistics, Medical School, University of Belgrade, Belgrade, Serbia.
J Med Biochem. 2016 Apr;35(2):158-165. doi: 10.1515/jomb-2016-0003. Epub 2016 May 9.
Since serial analyses of NT-proBNP in patients with acute coronary syndromes have shown that levels measured during a chronic, later phase are a better predictor of prognosis and indicator of left ventricular function than the levels measured during an acute phase, we sought to assess the association of NT-proBNP, measured 6 months after acute myocardial infarction (AMI), with traditional risk factors, characteristics of in-hospital and early postinfarction course, as well as its prognostic value and optimal cut-points in the ensuing 1-year follow-up.
Fasting venous blood samples were drawn from 100 ambulatory patients and NT-proBNP concentrations in lithium-heparin plasma were determined using a one-step enzyme immunoassay based on the »sandwich« principle on a Dimension RxL clinical chemistry system (DADE Behring-Siemens). Patients were followed-up for the next 1 year, for the occurrence of new cardiac events.
Median (IQR) level of NT-proBNP was 521 (335-1095) pg/mL. Highest values were mostly associated with cardiac events during the first 6 months after AMI. Negative association with reperfusion therapy for index infarction confirmed its long-term beneficial effect. In the next one-year follow-up of stable patients, multivariate Cox regression analysis revealed the independent prognostic value of NT-proBNP for new-onset heart failure prediction (p=0.014), as well as for new coronary events prediction (p=0.035). Calculation of the AUCs revealed the optimal NT-proBNP cut-points of 800 pg/mL and 516 pg/mL, respectively.
NT-proBNP values 6 months after AMI are mainly associated with the characteristics of early infarction and postinfarction course and can predict new cardiac events in the next one-year follow-up.
急性冠脉综合征患者的NT-proBNP系列分析表明，与急性期测得的水平相比，慢性后期测得的水平是更好的预后预测指标和左心室功能指标。因此，我们试图评估急性心肌梗死（AMI）6个月后测得的NT-proBNP与传统危险因素、住院及心肌梗死后早期病程特征的关联，以及其在随后1年随访中的预后价值和最佳切点。
从100例门诊患者中采集空腹静脉血样，使用基于“夹心”原理的一步酶免疫分析法在Dimension RxL临床化学系统（DADE Behring-Siemens）上测定锂肝素血浆中的NT-proBNP浓度。对患者进行接下来1年的随访，观察新的心脏事件发生情况。
NT-proBNP的中位数（IQR）水平为521（335 - 1095）pg/mL。最高值大多与AMI后前6个月的心脏事件相关。与首次梗死再灌注治疗呈负相关证实了其长期有益作用。在稳定患者接下来1年的随访中，多因素Cox回归分析显示NT-proBNP对新发心力衰竭预测（p = 0.014）以及对新发冠状动脉事件预测（p = 0.035）具有独立的预后价值。AUCs计算分别得出NT-proBNP的最佳切点为800 pg/mL和516 pg/mL。
AMI后6个月的NT-proBNP值主要与早期梗死及梗死后病程特征相关，并且可以预测接下来1年随访中的新心脏事件。
