BACKGROUND: We explored the value of admission levels of N-terminal pro-brain natriuretic peptide (NTProBNP) that best predicts poor myocardial tissue perfusion following primary percutaneous coronary intervention (PPCI) in patients admitted with acute ST-segment-elevation myocardial infarction (STEMI). METHODS: We enrolled 90 consecutive patients admitted with acute STEMI who underwent PPCI and achieved post-procedural TIMI flow grade 3 in the infarct-related artery. We measured levels of NTProBNP from admission blood samples. Thereafter, we assessed post-procedural myocardial blush grade (MBG) at the end of PPCI, and further measured ST segment resolution (STR) 90 minutes following PPCI. The primary endpoint was STR < 50%; furthermore, the co-primary angiographic endpoint was postprocedural MBG 0/1. RESULTS: The mean age of study subjects was 53.6 ± 10.9 years (74.4% males). We found that NTProBNP was higher in patients with STR < 50% versus those with STR ≥ 50% (p < 0.001), and in patients with post-procedural MBG 0/1 versus those with MBG 2/3 (p < 0.001). A value of NTProBNP ≥ 420 ng/L was the optimal cutoff value that best predicted < 50% STR; it predicted < 50% STR with sensitivity, specificity, positive and negative predictive value of 98.4%, 92.3%, 96.9%, and 96%, respectively. Likewise, a value of NTProBNP ≥ 570 ng/L was the optimal cutoff value that best predicted postprocedural MBG 0/1; it predicted MBG 0/1 with sensitivity, specificity, positive and negative predictive value of 92.2%, 66.7%, 78.3%, and 86.7%, respectively. CONCLUSIONS: In patients with STEMI who underwent PPCI and ended up with successful recanalization of the epicardial infarct-related artery, elevated admission levels of NTProBNP predicted incomplete post-procedural STR with good sensitivity and specificity, and predicted poor post-procedural myocardial blush with good sensitivity and moderate specificity.
BACKGROUND: We explored the value of admission levels of N-terminal pro-brain natriuretic peptide (NTProBNP) that best predicts poor myocardial tissue perfusion following primary percutaneous coronary intervention (PPCI) in patients admitted with acute ST-segment-elevation myocardial infarction (STEMI). METHODS: We enrolled 90 consecutive patients admitted with acute STEMI who underwent PPCI and achieved post-procedural TIMI flow grade 3 in the infarct-related artery. We measured levels of NTProBNP from admission blood samples. Thereafter, we assessed post-procedural myocardial blush grade (MBG) at the end of PPCI, and further measured ST segment resolution (STR) 90 minutes following PPCI. The primary endpoint was STR < 50%; furthermore, the co-primary angiographic endpoint was postprocedural MBG 0/1. RESULTS: The mean age of study subjects was 53.6 ± 10.9 years (74.4% males). We found that NTProBNP was higher in patients with STR < 50% versus those with STR ≥ 50% (p < 0.001), and in patients with post-procedural MBG 0/1 versus those with MBG 2/3 (p < 0.001). A value of NTProBNP ≥ 420 ng/L was the optimal cutoff value that best predicted < 50% STR; it predicted < 50% STR with sensitivity, specificity, positive and negative predictive value of 98.4%, 92.3%, 96.9%, and 96%, respectively. Likewise, a value of NTProBNP ≥ 570 ng/L was the optimal cutoff value that best predicted postprocedural MBG 0/1; it predicted MBG 0/1 with sensitivity, specificity, positive and negative predictive value of 92.2%, 66.7%, 78.3%, and 86.7%, respectively. CONCLUSIONS: In patients with STEMI who underwent PPCI and ended up with successful recanalization of the epicardial infarct-related artery, elevated admission levels of NTProBNP predicted incomplete post-procedural STR with good sensitivity and specificity, and predicted poor post-procedural myocardial blush with good sensitivity and moderate specificity.
Authors: L Agati; P Voci; P Hickle; D C Vizza; C Autore; F Fedele; S B Feinstein; A Dagianti Journal: J Am Coll Cardiol Date: 1998-02 Impact factor: 24.094
Authors: Kristian Thygesen; Joseph S Alpert; Allan S Jaffe; Maarten L Simoons; Bernard R Chaitman; Harvey D White; Hugo A Katus; Bertil Lindahl; David A Morrow; Peter M Clemmensen; Per Johanson; Hanoch Hod; Richard Underwood; Jeroen J Bax; Robert O Bonow; Fausto Pinto; Raymond J Gibbons; Keith A Fox; Dan Atar; L Kristin Newby; Marcello Galvani; Christian W Hamm; Barry F Uretsky; Ph Gabriel Steg; William Wijns; Jean-Pierre Bassand; Phillippe Menasché; Jan Ravkilde; E Magnus Ohman; Elliott M Antman; Lars C Wallentin; Paul W Armstrong; Maarten L Simoons; James L Januzzi; Markku S Nieminen; Mihai Gheorghiade; Gerasimos Filippatos; Russell V Luepker; Stephen P Fortmann; Wayne D Rosamond; Dan Levy; David Wood; Sidney C Smith; Dayi Hu; José-Luis Lopez-Sendon; Rose Marie Robertson; Douglas Weaver; Michal Tendera; Alfred A Bove; Alexander N Parkhomenko; Elena J Vasilieva; Shanti Mendis Journal: Circulation Date: 2012-08-24 Impact factor: 29.690
Authors: Gregg W Stone; Michael A Peterson; Alexandra J Lansky; George Dangas; Roxana Mehran; Martin B Leon Journal: J Am Coll Cardiol Date: 2002-02-20 Impact factor: 24.094
Authors: H Yasue; M Yoshimura; H Sumida; K Kikuta; K Kugiyama; M Jougasaki; H Ogawa; K Okumura; M Mukoyama; K Nakao Journal: Circulation Date: 1994-07 Impact factor: 29.690
Authors: Jay S Shavadia; Christopher B Granger; Wendimagegn Alemayehu; Cynthia M Westerhout; Thomas J Povsic; Sean Van Diepen; Christopher Defilippi; Paul W Armstrong Journal: J Am Heart Assoc Date: 2020-06-17 Impact factor: 5.501