Serum B-type natriuretic peptide levels on admission predict not only short-term death but also angiographic success of procedure in patients with acute ST-elevation myocardial infarction treated with primary angioplasty

Grabowski, Marcin; Filipiak‬, Krzysztof J.; Karpiński, Grzegorz; Wretowski, Dominik; Rdzanek, Adam; Huczek, Zenon; Horszczaruk, Grzegorz J.; Kochman, Janusz; Rudowski, Robert; Opolski, Grzegorz

doi:10.1016/j.ahj.2004.04.023

Cited by 57 publications

(42 citation statements)

References 18 publications

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“…Thus, we studied lower risk STEMI patients. This could be the explanation why, in contrast to some previous studies, lower mean admission BNP concentrations 8,16) were found. Moreover, in such a selected study population, in-hospital mortality and the rate of serious adverse events were low.…”

Section: Discussioncontrasting

confidence: 54%

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The Benefits of Repeated Measurements of B-type Natriuretic Peptide in Patients With First ST-Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention

Kuklinska¹,

Sobkowicz²,

Kamiński³

et al. 2006

Int. Heart J.

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SUMMARYBackground: Elevated B-type natriuretic peptide levels in patients with acute myocardial infarction are useful in the prediction of poor outcome. It is still not established how often and when assessment of neurohormonal activation provides the best prognostic information. Aim:To evaluate whether repeated measurements of B-type natriuretic peptide provide additional clinical information in patients with first ST-elevation myocardial infarction. Methods:In 96 consecutive patients with first ST-elevation myocardial infarction, treated with primary percutaneous coronary intervention, B-type natriuretic peptide concentrations were measured twice: on admission and 24 hours later. A clinical composite endpoint was assessed during hospital stay. Results:The median B-type natriuretic peptide concentration obtained on admission was 62.9 pg/mL and 24 hours later was 223.6 pg/mL. Thirty-five patients (36.4%) reached composite endpoint, including 3 deaths (3.1%). Both B-type natriuretic peptide levels were related to the clinical and echocardiographic variables, which refer to the large infarct expansion and acute left ventricular dysfunction. The first measurement was better correlated with current patient status (ie, TIMI Risk Score, admission Killip class). B-type natriuretic peptide 24 hours after admission was significantly higher in patients who had an adverse cardiovascular event during hospitalization (P = 0.02). ROC analysis also identified the second B-type natriuretic peptide measurement as significant to estimate adverse outcome (c = 0.64 CI 0.527 -0.756 P = 0.007). Conclusions:Despite there being a time interval of only 24 hours between the two sets of B-type natriuretic peptide sampling, both measurements provide important and different information. Only B-type natriuretic peptide measurement 24 hours after admission From the Departments of 1 Cardiology,

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Section: Discussioncontrasting

confidence: 54%

“…16) In addition, they also showed that BNP corresponded well with angiographic success after PCI, but the second measurement after angioplasty was not obtained. The findings of this study are not consistent with these previous studies.…”

Section: Discussionmentioning

confidence: 98%

The Benefits of Repeated Measurements of B-type Natriuretic Peptide in Patients With First ST-Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention

Kuklinska¹,

Sobkowicz²,

Kamiński³

et al. 2006

Int. Heart J.

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“…15,16 Few data are available for the predictive value of BNP levels obtained on admission in patients with STEMI, before introducing primary PCI. 17 Grabowski et al recanalized the 126 STEMI patients with primary PCI using uncoated stent implantation (81.7%) and balloon angioplasty (18.3%). 17 During 42 d follow-up after procedure, 10 (7.9%) patients died.…”

Section: Discussionmentioning

confidence: 99%

“…17 Grabowski et al recanalized the 126 STEMI patients with primary PCI using uncoated stent implantation (81.7%) and balloon angioplasty (18.3%). 17 During 42 d follow-up after procedure, 10 (7.9%) patients died. Their mortality rate was somewhat higher than expected from current data 18,19 and was 2.0-fold higher compared with 1-y death from our data (3.9%).…”

Section: Discussionmentioning

confidence: 99%

Biomarkers on Admission for the Prediction of Cardiovascular Events After Primary Stenting in Patients with ST‐Elevation Myocardial Infarction

Jeong

Lee

et al. 2008

Clinical Cardiology

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Background: Several cardiac biomarkers have been shown to have predictive values for the development of cardiovascular disease and clinical outcome after events, and are now broadly used by clinicians. Little is known about the utility of these biomarker values on admission in ST-elevation myocardial infarction (STEMI) cases of primary drug-eluting stent (DES) implantation and intense medical therapy. Hypothesis: Because little is known about the utility of these biomarkers on admission in ST-elevation myocardial infarction (STEMI) in cases primary drug-eluting stent (DES) implantation and intense medical therapy, we evaluated clinical outcomes. Methods: We enrolled 207 consecutive STEMI patients treated with primary stenting (mean age, 57.3±12.0 y). We evaluated the association between B-type natriuretic peptide (BNP), cardiac troponin I (cTnI), highsensitivity C-reactive protein (hs-CRP) on admission, and death, reinfarction, and new or worsening congestive heart failure (CHF) through 1 y. Results: In backward-elimination models including all biomarkers, only the cTnI level was retained as a predictor of 1-y CHF (odds ratio [OR]: 1.017, 95% confidence interval [CI]: 1.001-1.034, p = 0.039). There were no predictors in terms of 1-y death, reinfarction, and composite endpoint. When we applied a simple score system, in which patients were categorized on the basis of the number of elevated biomarkers, the 1-y risks of death (p = 0.600), reinfarction (p = 0.185), and composite endpoint (p = 0.620) did not increase in proportion to the number of elevated biomarkers on admission. One-y CHF only tended to increase according to the number of elevated biomarkers (p = 0.067). Conclusions:The use of cardiac biomarkers on admission, in each or in combination, had only a minimal impact for the prediction of long-term cardiovascular events after primary stenting in STEMI patients.

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“…Tirofiban, a glycoprotein (GP) IIb/IIIa receptor antagonist, is used recently for this purpose. A number of studies have investigated the relationship between the angiographic TIMI 3 flow and cardiac biomarkers (myocardial damage, inflammation markers and natriuretic peptides) (6)(7)(8). In acute STEMI, a relationship was found between the serum B-type natriuretic peptide (BNP) level, short and long-term mortality with post primary PCI angiographic success and reperfusion disorder (9,10).…”

Section: Introductionmentioning

confidence: 99%

Changes in BNP, hs-CRP and TIMI risk index with addition of tirofiban during primary percutaneous coronary intervention for acute STEMI: a prospective observational cohort study

Kurt¹,

Demırkol²,

Ünal³

et al. 2012

Anadolu Kardiyol Derg

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Objective: This study aimed to investigate the relationship of tirofiban, added to the treatment of acute ST-elevation myocardial infarction (STEMI) patients underwent primary percutaneous coronary intervention (PCI), with changes in the TIMI risk index (TRI) of TIMI flow, B-type natriuretic peptide (BNP) and high-sensitive C-reactive protein (hs-CRP) levels. Methods: This single-center, prospective observational cohort study included 102 consecutive patients who were admitted with the diagnosis of acute STEMI (70 male; 54.9±10.4 years). Primary PCI was applied to all cases with STEMI, who applied to our hospital in the first 6 hours due to chest pain complaints. Tirofiban was administered to one group (n=55) (male: 36; 54.1±11.3 years), while the other group was not given tirofiban (n=47) (male: 34; 55.9±9.1 years). The primary end-point was TIMI flow 2 or 3 for reperfusion after primary PCI. Chi-square test, paired t-test or Wilcoxon signed rank test, Spearman correlation analysis and Kaplan-Meier survival analysis were used for statistical analysis where appropriate. Results: BNP level remained the same in the tirofiban group, whereas a significant increase was observed in the group that was not treated with tirofiban (105.9±126.8 versus 261.3±202.3 pg/ml p<0.001). The hs-CRP level tended to rise significantly in both groups despite the treatment (tirofiban group -from 0.67±0.66 to 0.90±0.44 mg/L, p=0.015, non tirofiban group -from 0.51±0.43 to 1.08±0.74 mg/L, p<0.001). BNP and hs-CRP values remained the same in cases with TIMI 2 flow in the tirofiban group, whereas a significant increase was detected in the post-treatment BNP (before 97.8±122.3 after 281.6±217.3 pg/ml, p=0.011) and hs-CRP (before 0.65±0.69; after 1.33±0.80 mg/L, p=0.028) values in the group not treated with tirofiban. In patients with TIMI 3 flow, BNP (tirofiban group before 146.5±114.2; after 184.4±139.4 pg/ml, p=0.011, non tirofiban group before 172.1±297.9; after 295.9±384.9 pg/ml, p<0.001) and hs-CRP levels (tirofiban group before 0.66±0.58; after 0.92±0.65 mg/L, p=0.011, non tirofiban group before 0.81±0.74; after 1.45±1.23 mg/L, p<0.001) were found to be similarly reduced in both treatment groups p<0.05. Three patients with minor hemorrhage did not need blood transfusion. Conclusion: It was concluded at the end of them PCI application in STEMI that the addition of tirofiban treatment in patients with ≥TIMI 2 flow and anterior location MI could decrease the expected rise in BNP and CRP values. (Anadolu Kardiyol Derg 2012; 12: 107-14) Key words: Acute myocardial infarction, tirofiban, percutaneous coronary intervention, TIMI risk index, B-type natriuretic peptide, high-sensitive C-reactive protein 107 ÖZET Amaç: Bu çalışmada primer perkütan koroner girişim (PPCI) uygulanan akut ST elevasyonlu miyokart enfarktüslü olgularda (STEMI) tedaviye eklenen tirofibanın anjiyografik TIMI akım (The Thrombolysis in Myocardial Infarction), TIMI risk indeksi, serum B-tip natriüretik peptit, (BNP) ve yüksek-duyarlıklı C-reaktif protein (hs-CRP...

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Serum B-type natriuretic peptide levels on admission predict not only short-term death but also angiographic success of procedure in patients with acute ST-elevation myocardial infarction treated with primary angioplasty

Cited by 57 publications

References 18 publications

The Benefits of Repeated Measurements of B-type Natriuretic Peptide in Patients With First ST-Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention

The Benefits of Repeated Measurements of B-type Natriuretic Peptide in Patients With First ST-Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention

Biomarkers on Admission for the Prediction of Cardiovascular Events After Primary Stenting in Patients with ST‐Elevation Myocardial Infarction

Changes in BNP, hs-CRP and TIMI risk index with addition of tirofiban during primary percutaneous coronary intervention for acute STEMI: a prospective observational cohort study

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