NT-proBNP level before primary PCI and risk of poor myocardial reperfusion: insight from the On-TIME II trial
Background - N-terminal fragment of the brain natriuretic peptide prohormone (NT-proBNP), a marker for neurohumoral activation, has been associated with adverse outcome in patients with myocardial infarction. NT-proBNP levels may reflect extensive ischemia and microvascular damage, therefore we inve...
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| Main Authors: | , , , , , , , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
2021
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| In: |
American heart journal
Year: 2021, Volume: 233, Pages: 78-85 |
| ISSN: | 1097-6744 |
| DOI: | 10.1016/j.ahj.2020.12.017 |
| Online Access: | Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1016/j.ahj.2020.12.017 Verlag, lizenzpflichtig, Volltext: https://www.sciencedirect.com/science/article/pii/S0002870320304269 
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| Author Notes: | Enrico Fabris, MD, PhD, Jurrien M. ten Berg, MD, PhD, Renicus S. Hermanides, MD, PhD, Jan Paul Ottervanger, MD, PhD, Jan Henk E Dambrink, MD, PhD, AT Marcel Gosselink, MD, PhD, Gianfranco Sinagra, MD, Petra C.Koopmans, PhD, Evangelos Giannitsis, MD, PhD, ChristianHamm, MD, PhD, and Arnoud W.J. van’t Hof, MD, PhD |
| Summary: | Background - N-terminal fragment of the brain natriuretic peptide prohormone (NT-proBNP), a marker for neurohumoral activation, has been associated with adverse outcome in patients with myocardial infarction. NT-proBNP levels may reflect extensive ischemia and microvascular damage, therefore we investigated the potential association between baseline NT-proBNP level and ST-resolution (STR), a marker of myocardial reperfusion, after primary percutaneous coronary intervention (pPCI). - Methods - we performed a post-hoc analysis of the On-TIME II trial (which randomized ST-elevation myocardial infarction (STEMI) patients to pre-hospital tirofiban administration vs placebo). Patients with measured NT-proBNP before angiography were included. Multivariate logistic-regression analyses was performed to investigate the association between baseline NTproBNP level and STR one hour after pPCI. - Results - Out of 984 STEMI patients, 918 (93.3%) had NT-proBNP values at baseline. Patients with STR <70% had higher NT-proBNP values compared to patients with complete STR (>70%) [Mean ±SD 375.2 ±1021.7 vs 1007.4 ±2842.3, Median (IQR) 111.7 (58.4-280.0) vs 168.0 (62.3-601.3), P <.001]. At multivariate logistic regression analysis, independent predictors associated with higher risk of poor myocardial reperfusion (STR <70%) were: NT-proBNP (OR 1.17, 95%CI 1.04-1.31, P=.009), diabetes mellitus (OR 1.87, 95%CI 1.14-3.07, P=.013), anterior infarct location (OR 2.74, 95% CI 2.00-3.77, P <.001), time to intervention (OR 1.06, 95%CI 1.01-1.11, P=.021), randomisation to placebo (OR 1.45, 95%CI 1.05-1.99, P=.022). - Conclusions - In STEMI patients, higher baseline NT-proBNP level was independently associate with higher risk of poor myocardial reperfusion, supporting the potential use of NT-proBNP as an early marker for risk stratification of myocardial reperfusion after pPCI in STEMI patients. |
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| Item Description: | Available online 31 December 2020 Gesehen am 07.09.2021 |
| Physical Description: | Online Resource |
| ISSN: | 1097-6744 |
| DOI: | 10.1016/j.ahj.2020.12.017 |