N 末端脑利钠肽前体水平的早期变化可预测 STEMI 患者新发心力衰竭。
Early changes in N-terminal pro-brain natriuretic peptide levels predict new-onset heart failure in patients with STEMI.
机构信息
Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Pauley Heart Center, Richmond, VA, USA.
Department of Cardiovascular and Thoracic Sciences, Sacred Heart Catholic University, Rome, Italy.
出版信息
Minerva Cardiol Angiol. 2022 Feb;70(1):25-31. doi: 10.23736/S2724-5683.20.05303-7. Epub 2020 Jul 10.
BACKGROUND
Previous studies suggested that N-terminal pro-brain natriuretic peptide (NT-proBNP) level is a powerful independent predictor of death or heart failure (HF) when measured at admission in patients with chest pain or acute coronary syndrome. Little is known about the role of NT-proBNP level measured during a hospitalization for ST segment elevation myocardial infarction (STEMI) in predicting clinical outcomes. We evaluated the optimal NT-proBNP timing (admission, 72 hours, or delta [Δ] NT-proBNP [72 hours minus admission]) to predict 1-year new-onset HF in STEMI patients.
METHODS
We measured NT-proBNP levels at admission and 72 hours in 72 patients with STEMI. HF events were adjudicated and defined as hospitalization for HF or need for new initiation of a loop diuretic at 1-year follow-up. Values are presented as medians and interquartile range or frequencies (%) as appropriate. Cox regression analysis was used to determine predictors of adverse events. A receiver-operative-curve was constructed to identify the discriminative value and optimal cut-off points for NT-proBNP.
RESULTS
Patients (age 56 [49-64] years, males 59 [82%]) were followed for a median duration of 365 [180-365] days. HF events were recorded in 9 (12.5%) patients. NT-proBNP values at admission, 72 hours, and ΔNT-proBNP were 89 (26-268) pg/mL, 452 (223-1064) pg/mL, and 283 (68-686) pg/mL, respectively. NT-proBNP at 72 hours and ΔNT-proBNP, but not admission NT-proBNP predicted new-onset HF events at follow-up (P=0.03, P=0.002 and P=0.89, respectively). The optimal area under the curve of 0.771 (95%, CI [0.630-0.912], P= 0.009) and cut-off value of 830 pg/mL (sensitivity 79%; specificity 76%) were found for NT-proBNP at 72 hours. The Kaplan-Meier survival curves for NT-proBNP at 72 hours dichotomized above and below this cut-off value, confirmed NT-proBNP at 72 hours >830 pg/mL as predictive of HF events (log-rank statistic = 8.688, P=0.003).
CONCLUSIONS
NT-proBNP level at 72 hours and ΔNT-proBNP (72 hours minus admission), but not at time of admission, predicted HF events in patients following STEMI.
背景
先前的研究表明，在胸痛或急性冠状动脉综合征患者入院时测量的 N 端脑利钠肽前体（NT-proBNP）水平是死亡或心力衰竭（HF）的有力独立预测因子。在 ST 段抬高型心肌梗死（STEMI）住院期间测量 NT-proBNP 水平对预测临床结局的作用知之甚少。我们评估了最佳 NT-proBNP 时间（入院时、72 小时或 Δ NT-proBNP[72 小时减去入院时]），以预测 STEMI 患者 1 年内新发 HF。
方法
我们在 72 例 STEMI 患者入院时和 72 小时测量 NT-proBNP 水平。HF 事件由判定，并定义为 HF 住院或需要在 1 年随访时开始使用新型利尿剂。数值以中位数和四分位距（IQR）表示，或根据情况表示为频率（%）。Cox 回归分析用于确定不良事件的预测因素。构建受试者工作特征曲线以确定 NT-proBNP 的鉴别价值和最佳截断值。
结果
中位随访 365 [180-365] 天，共记录到 9 例（12.5%）HF 事件。入院时、72 小时和 Δ NT-proBNP 的 NT-proBNP 值分别为 89（26-268）pg/mL、452（223-1064）pg/mL 和 283（68-686）pg/mL。入院时的 NT-proBNP、72 小时的 NT-proBNP 和 Δ NT-proBNP 可预测随访时的新发 HF 事件（P=0.03、P=0.002 和 P=0.89）。72 小时 NT-proBNP 的最佳曲线下面积为 0.771（95%CI[0.630-0.912]，P=0.009），最佳截断值为 830 pg/mL（灵敏度 79%，特异性 76%）。72 小时 NT-proBNP 大于或小于该截断值的 Kaplan-Meier 生存曲线，证实 72 小时 NT-proBNP>830 pg/mL 可预测 HF 事件（对数秩检验=8.688，P=0.003）。
结论
STEMI 患者 72 小时和 Δ NT-proBNP（72 小时减去入院时）而不是入院时的 NT-proBNP 水平可预测 HF 事件。
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