Synopsis
Serum levels of the cardiac neurohormone B-type natriuretic peptide (BNP) can predict mortality in patients with acute coronary syndromes. Grabowski et al . explored the link between patients' BNP levels immediately after admission for ST-elevation myocardial infarction (STEMI), short-term mortality and outcome of angiographic intervention.
To find out whether levels of BNP at the time of STEMI can be used to predict the success of primary percutaneous coronary intervention and short-term risk of death from any cause.
Between November 2002 and February 2003, men and women admitted for STEMI at the Central University Hospital, Warsaw, were included in this prospective study. Patients were assessed by electrocardiogram immediately after presentation at hospital. Eligible patients had ST-segment elevation of at least 1 mm in at least two leads on the electrocardiogram. Medical history and demographic information were recorded for all patients.
Patients gave peripheral blood samples for BNP measurement using the Triage BNP Test (Biosite Incorporated, San Diego, CA, USA) within 15 min of collection. Immediately after assessment, all patients underwent angiography and primary percutaneous coronary intervention. The success of intervention was evaluated by blood flow grade (Innova 2000 system, General Electrics Company, Fairfield, CT, USA) and coronary blood flow pattern (using the Thrombolysis In Myocardial Infarction [TIMI] blood flow scale). Whether patients were alive or had died from any cause was recorded 42 days after intervention.
The outcomes were death from any cause, failure of percutaneous coronary intervention defined by the no-reflow phenomenon, and BNP levels.
In total, 126 patients (mean age 58.8 years, 28.6% female) with STEMI received angiographic intervention. Patients' median BNP concentration was 100 pg/ml, the mean serum BNP concentration was 183.5 ± 241.3 pg/ml. At 42 days, 10 (7.9%) patients had died. These patients had significantly higher baseline BNP levels than those who survived (584.4 ± 269.1 vs 148.9 ± 206.1 pg/ml, P <0.0001). More patients with BNP concentrations above 100 pg/ml but low TIMI score died than those with concentrations below 100 pg/ml with low TIMI score (1 vs 9, respectively; P = 0.027). Patients with high TIMI risk scores (≥4) and BNP concentrations >100 pg/ml had the highest number of deaths (25.8%). Despite successful intervention, the no-reflow phenomenon was seen in 18 patients, of whom 15 had BNP levels >100 pg/ml (427.3 ± 362.9 vs 142.8 ± 188.3 pg/ml, P <0.0001). From the survival analysis a BNP concentration of 331 pg/ml at admission was shown to have 90% specificity and 87.9% sensitivity for predicting death.
Serum BNP concentrations upon admission for STEMI can predict the outcome of percutaneous coronary intervention and early death. Grabowski et al . suggest that BNP assays could be used as a tool for risk assessment in patients hospitalized for STEMI.
Nat Clin Pract Cardiovasc Med. 2005;2(2):72-73. © 2005 Nature Publishing Group
Cite this: Do Serum B-type Natriuretic Peptide Levels Predict Short-Term Mortality and Angiographic Success? - Medscape - Feb 01, 2005.
