High levels of N-terminal pro B-type natriuretic peptide are associated with ST resolution failure after reperfusion for acute myocardial infarction

摘要

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 90min 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.