N-terminal pro-brain natriuretic peptide and the timing, extent and mortality in ST elevation myocardial infarction.
Journal Article (Journal Article)
AIMS: While natriuretic peptides have demonstrated diagnostic and prognostic potential in cardiac disorders, little is known about their relationship with the onset and quantification of myocardial infarction. The relationship of serial N-terminal pro-brain natriuretic peptide (NT-proBNP) with duration from symptom onset, infarct size and prognosis in ST elevation myocardial infarction (STEMI) patients treated with primary percutaneous intervention was examined. METHODS AND RESULTS: Three hundred thirty-one STEMI patients in the COMplement inhibition in Myocardial infarction treated with Angioplasty (COMMA) trial, which evaluated pexelizumab versus placebo, were studied. NT-proBNP (pg/mL) was measured at randomization, 24 h and 72 h; creatine kinase-MB area under the curve was measured at 72 h; and QRS score was assessed at discharge. Prognosis was ascertained from the 90-day composite clinical outcome of death, shock, stroke and congestive heart failure. Multivariate logistical regression was used to adjust for baseline characteristics for models at randomization, 24 h and 72 h. NT-proBNP was higher in patients with longer time from symptom onset (P<0.001) and correlated with measures of infarct size, including the area under the curve (P<0.001) and QRS score (P<0.001). Patients reaching the primary end point had markedly higher NT-proBNP at each sampling period (P<0.001). NT-proBNP at all time points was the strongest independent predictor of the primary end point in the multivariate model: in the 24 h model, only age and 24 h NT-proBNP (C-index 0.83); and only age, Killip class and NT-proBNP was in the 72 h model (C-index 0.85). CONCLUSIONS: Higher NT-proBNP at 24 h correlated with larger infarct size and worse clinical outcomes. NT-proBNP at baseline, 24 h and 72 h after presentation with acute STEMI, is an independent predictor of a poor outcome and adds clinically useful prognostic information.
Full Text
Duke Authors
Cited Authors
- Ezekowitz, JA; Théroux, P; Chang, W; Mahaffey, KW; Granger, CB; Weaver, WD; Hochman, JS; Armstrong, PW
Published Date
- April 2006
Published In
Volume / Issue
- 22 / 5
Start / End Page
- 393 - 397
PubMed ID
- 16639474
Pubmed Central ID
- PMC2560534
International Standard Serial Number (ISSN)
- 0828-282X
Digital Object Identifier (DOI)
- 10.1016/s0828-282x(06)70924-2
Language
- eng
Conference Location
- England