High levels of N-terminal pro B-type natriuretic peptide are associated with ST resolution failure after reperfusion for acute myocardial infarction
1From the Service de Cardiologie, CHU Bocage, Dijon, 2IFR santé STIC, Université de Bourgogne, 3Service de Cardiologie, Clinique de Fontaine, Fontaine les Dijon, 4Service de Cardiologie, Centre Hospitalier, Semur en Auxois, 5Service de Cardiologie, Centre Hospitalier, Beaune, 6Service de Cardiologie, Centre Hospitalier, Châtillon sur Seine, and 7Laboratoire de Biochimie, CHU Bocage, Dijon, France
Address correspondence to Dr Y. Cottin, Service de Cardiologie, CHU Dijon, Bd de Lattre de Tassigny, 21034 Dijon Cedex, France. email: yves.cottin{at}chu-dijon.fr
Received 26 September 2006 and in revised form 29 December 2006
 |
Abstract |
|---|
Background: B-type natriuretic peptide and the N-terminal fragment of its prohormone, N-terminal pro-brain natriuretic peptide (Nt-proBNP), provide valuable prognostic information on short- and long-term mortality in patients with acute coronary syndrome
Aim: To investigate the association between plasma NT-proBNP levels and ST-segment resolution (STR) after reperfusion in patients with ST-segment elevation myocardial infarction (STEMI).
Methods: Consecutive patients from the French regional RICO survey with STEMI who were treated by primary PCI or lysis <12 h were included. Blood sample was taken on admission to measure plasma NT-proBNP. Maximal ST segment elevation was measured on the single worst ECG lead before and 90 min after reperfusion. Patients were categorized as STR(–) (<50% STR) or STR(+) (
50% STR).
Results: Of the 486 patients included, 133 (27%) were STR(–). STR(–) patients had similar cardiovascular risk factors but higher in-hospital mortality (5% vs. 1%, p = 0.03) than STR(+) patients. The STR(–) group had higher median (IQR) levels of Nt-proBNP: 938 (211–3272) vs. 533 (169–1471) pg/ml, p = 0.003. On multivariate analysis, the highest quartile of Nt-ProBNP, Q waves and lysis were independent risk factors for incomplete STR.
Discussion: Our data show a strong association between high levels of Nt-proBNP at admission and incomplete STR, suggesting that Nt-proBNP may be useful for early risk stratification in reperfusion therapy after acute myocardial infarction.