N‐terminal Pro‐brain Natriuretic Peptide in the Elderly with Myocardial Infarction

Abstract

Background:The myocardial infarction (MI) results in the change of the levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) in blood. In addition, attention is paid to the dependence of NT-proBNP levels on the patients' age. However, the behavior of natriuretic peptide levels has not been recognized well enough in the elderly with MI treated with invasive methods. Hypothesis: The aim of the study was to estimate the effect of age on NT-proBNP levels in patients with first MI, and treated with primary percutaneous coronary intervention (PCI) with complete coronary revascularization. Methods: One hundred and sixty-one consecutive patients with first ST-elevation MI, and treated with primary PCI with stent implantation (occlusion in infarct-related artery was the patient's only lession) were included. Determination of NT-proBNP level and echocardiography were performed on the 4th-5th day of MI. Results: Thirty-seven patients (23%) aged >65 y were considered as a study group. The NT-proBNP levels were nearly 4-fold higher in older patients than in younger patients. Only systolic and diastolic dysfunction, mitral regurgitation, troponin T levels, and glomerular filtration rate (GFR) were independent risk factors of the occurrence of elevated NT-proBNP concentration above median. Conclusions: The patients' age was not a factor independently affecting the increase of NT-proBNP level above the median in patients with first MI and treated successfully with primary PCI. Independently associated elevated levels of NT-proBNP were as follows: presence of diastolic dysfunction, mitral regurgitation, left ventricular systolic dysfunction, troponin T concentration, and GFR.Key words: myocardial infarction, coronary disease, natriuretic peptides, elderly patients BackgroundThe percentage of elderly subjects, defined as those >65 y of age, increases with the lengthening of the mean life time of population. Cardiovascular diseases such as arterial hypertension; ischemic heart disease, in particular myocardial infarction (MI); or valvular heart disease occur in about 75% of advanced age subjects. All these pathologies contribute to heart failure (HF) frequently observed in elderly people.The natriuretic peptides have diuretic, natriuretic, and vasodilating activity; however, type-B peptides (brain natriuretic peptide [BNP] and N-terminal pro-brain natriuretic peptide [NT-proBNP]), show stronger biological properties than atrial natriuretic peptide (ANP) and are currently widely used in diagnostics. 1 Determination of BNP and NTproBNP play an important role in the diagnosis of chronic HF independently of its aetiology. 2 The use of natriuretic peptides were demonstrated in different cardiac and other causes of acute dyspnoea in the patients of the emergency department. 3,4 Moreover, elevated values of their levels are prognostic factors of death and development of HF in the course of acute coronary syndromes. 5 -7 In the literature, attention is paid to the dependence of type-B natriuretic peptides levels (particularly ...