NT-proBNP Level Predicts Extent of Myonecrosis and Clinical Adverse Outcomes in Patients with ST-Elevation Myocardial Infarction: A Pilot Study

Abstract

Background and Hypothesis: The initial assessment of late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (CMR) reflects cardiac damage and is an important prognostic factor in patients with acute ST-elevation myocardial infarction (STEMI). N-Terminal prohormone of brain natriuretic peptide (NT-proBNP) is released following cardiomyocytes injury. However, the relationship between NT-proBNP levels, myocardial damage and clinical outcomes after STEMI has not been well defined. Methods: Plasma levels of NT-proBNP, troponin I and creatinine kinase (CK) were assessed in 75 patients with STEMI. Echocardiography and CMR were performed prior to hospital discharge. Cardiac damage was quantified using peak biomarker levels and LGE. Patients were followed for a median of 975 days (IQR 823-1098 days) for major adverse cardiac events (MACE) (all-cause mortality, recurrent myocardial infraction, unplanned recurrent revascularization and recurrent hospitalization for heart failure). Results: Plasma levels of NT-proBNP increased following STEMI to peak at 24 hours. The dynamic changes in plasma NT-proBNP were similar to those noted with troponin I and its delayed peak but not those observed with plasma CK levels. Peak NT-proBNP levels correlated positively with indices of myocardial damage such as peak troponin I (R =0.38, P <0.001), peak CK (R =0.22, P = 0.01) and LGE examination (R = 0.46, P <0.001). Peak plasma level of NT-proBNP was strongly predictive of MACE during the follow-up period. Conclusions: Peak levels of NT-proBNP following STEMI are predictive of the extent of myocardial damage and clinical outcomes. These results suggest an important prognostic role for NT-proBNP assessment in STEMI patients.

The Predictive Value of Estimation of N Terminal - Pro B- Type Natriuretic Peptide in Patients with ST Elevation Myocardial Infarction Undergoing Primary Percutaneous Intervention for the Outcome of Myocardial Reperfusion

“…Shavadia et al (19) have found that only one biomarker (higher pre-PCI NT-pro BNP levels) was connected to a congestive heart failure, notably higher 90-day risk of death, and cardiogenic shock. This also agrees with the findings of Qin et al (20) and Mathbout et al (22) who revealed that NT-pro BNP was a crucial predictor of MACE in cases with STEMI. These findings suggest that early risk stratification of cases at high risk for poor myocardial reperfusion including NT-pro BNP measurement is very important.…”

Novel grading system for ischemia‒reperfusion injury manifestations in patients with acute ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention

“…The researchers found that the peak levels of CKMB and cTnT were significantly correlated with the infarct size and could predict mortality within 1 year 15 . The peak level of NT-proBNP was positively correlated with the severity of myocardial injury and the risk of adverse prognosis in patients with acute myocardial infarction 16 . In this study, by monitoring the peak levels of hs-cTnT, CKMB and NT-proBNP, we found that the higher the MIRI manifestation grade of STEMI patients, the higher was the biomarker level of myocardial injury and the lower was the grade of STEMI patients who also had myocardial injury.…”

Dynamic change of sST2 predicts major adverse cardiovascular events in patients with ST-segment elevation myocardial infarction

“…The prognostic impact of NT-pro-BNP in STEMI patients has been anticipated in previous studies [23,24]. Mohammad et al [25] showed that the change in pNT-proBNP values following STEMI were predictive of the extent of myocardial damage and clinical outcomes. Sabatine MS et al [26] revealed the enhanced predictive and prognostic power of short-term risk stratification by exploiting the sST2 level change combined with the NT-proBNP level in STEMI patients.…”