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外文期刊>International heart journal
>Prognostic Impact of B-Type Natriuretic Peptide on Long-Term Clinical Outcomes in Patients with Non-ST-Segment Elevation Acute Myocardial Infarction Without Creatine Kinase Elevation A Japanese registry of acute Myocardial INfarction diagnosed by Universal dEfiniTion (J-MINUET) Substudy
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Prognostic Impact of B-Type Natriuretic Peptide on Long-Term Clinical Outcomes in Patients with Non-ST-Segment Elevation Acute Myocardial Infarction Without Creatine Kinase Elevation A Japanese registry of acute Myocardial INfarction diagnosed by Universal dEfiniTion (J-MINUET) Substudy
Although B-type natriuretic peptide (BNP) has gradually gained recognition as an indicator in risk stratification for patients with acute myocardial infarction (AMI), the prognostic impact on long-term clinical outcomes in patients with non-ST-segment elevation acute myocardial infarction (NSTEMI) without creatine kinase (CK) elevation remains unclear.This prospective multicenter study assessed 3,283 consecutive patients with AMI admitted to 28 institutions in Japan between 2012 and 2014. We analyzed 218 patients with NSTEMI without CK elevation (NSTEMI-CK) for whom BNP was available. In the NSTEMI-CK group, patients were assigned to high- and low-BNP groups according to BNP values (cut-off BNP, 100 pg/mL). The primary endpoint was defined as a composite of all-cause death, non-fatal myocardial infarction, non-fatal stroke, cardiac failure, and urgent revascularization for unstable angina up to 3 years. Primary endpoints were observed in 60 (33.3%) events among patients with NSTEMI-CK. Kaplan-Meier analysis revealed a significantly higher event rate for primary endpoints among patients with high BNP (log-rank P 0.001). After adjusting for covariates, a higher BNP level was significantly associated with long-term clinical outcomes in NSTEMI-CK (adjusted hazard ratio, 4.86; 95% confidence interval, 2.18-12.44; P 0.001).The BNP concentration is associated with adverse long-term clinical outcomes among patients with NSTEMI-CK who are considered low risk. Careful clinical management may be warranted for secondary prevention in patients with NSTEMI-CK with high BNP levels.
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机译：虽然B型Natriuretic肽（BNP）逐渐获得了急性心肌梗死患者风险分层（AMI）的指标，但对非ST段升高急性心肌梗死患者的长期临床结果的预后影响（NSTemi）没有肌酸激酶（CK）升级仍然不清楚。本期的多中心研究分析了3,283名连续患者，2012年和2014年间日本的28个机构录取。我们分析了218名NSTemi患者，没有CK海拔（Nstemi-CK） BNP可用。在Nstemi-CK组中，根据BNP值（截止BNP，100pg / mL）分配给高和低BNP组。主要终点被定义为全因死亡，非致命心肌梗死，非致命中风，心脏衰竭以及不稳定的心绞痛的紧急血运重建的综合性，长达3年。在Nstemi-CK患者的60例（33.3％）事件中观察到初级终点。 Kaplan-Meier分析显示高BNP患者的主要终点的事件率显着更高（log-rank p <0.001）。调整协变量后，较高的BNP水平与Nstemi-CK中的长期临床结果显着相关（调整后的危险比，4.86; 95％置信区间，2.18-12.44; p <0.001）。BNP浓度与不利相关Nstemi-CK患者的长期临床结果被认为是低风险的。仔细的临床管理可能需要进行NSTemi-CK患者的二次预防，具有高BNP水平。
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