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首页> 外文期刊>Canadian Journal of Physiology and Pharmacology >Insights into the change in brain natriuretic peptide after ST-elevation myocardial infarction (STEMI): why should it be better than baseline?
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Insights into the change in brain natriuretic peptide after ST-elevation myocardial infarction (STEMI): why should it be better than baseline?

机译：观察ST抬高型心肌梗死（STEMI）后脑钠肽的变化：为什么它比基线好？

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While baseline N-terminal brain natriuretic peptide (NT-proBNP) is useful in the prognosis of acute ST-elevation myocardial infarction (STEMI), it is unclear whether a relationship exists between serial NT-proBNP, reperfusion success, and prognosis. We prospectively defined a NT-proBNP analysis in the WEST (Which Early ST-elevation myocardial infarction Therapy) trial that enrolled 304 acute STEMI patients. NT-proBNP (pg/mL) was measured at baseline prior to treatment (n=258) and 72 to 96 h (n=247) and 30 days (n=221) after treatment (Delta NT-proBNP=72 h value - the baseline NT-proBNP). Reperfusion success was measured by ST-segment resolution at 180 min, infarct size by peak creatine kinase (CK) during the first 24 h, and QRS score at discharge (QRSd). The primary endpoint was a 30 day clinical composite. The ability of either baseline NT-proBNP or Delta NT-proBNP to predict the primary endpoint was compared using single-variable logistic regression and the c-statistic. Median (interquartile range) NT-proBNP in pg/mL was 87 (39-316) at baseline, 864 (338-1857) at 72 h, and 585 (264-1212) at 30 days. ST resolution was inversely correlated with Delta NT-proBNP (r=-0.23, p=0.002) and 30 day NT-proBNP (30 day NT-proBNP 1016, 828, and 397 for <30%, 30%-70%, >or=70% STR, respectively, p<0.001). Infarct size was correlated with Delta NT-proBNP by CK (r=0.41, p<0.001) and QRSd (r=0.31, p<0.001); the 30 day NT-proBNP relationship was similar for CK (r=0.48, p<0.001) and QRSd (p=0.003). The baseline NT-proBNP was associated with an increased 30-day composite endpoint (Q1, 19%; Q2, 20%; Q3, 15%; Q4, 38%; p=0.03 for trend) as was Delta NT-proBNP (Q1, 16%; Q2, 18%; Q3, 19%; Q4, 37%; p=0.009 for trend). The c-statistic for baseline, 72 to 96 h, and Delta NT-proBNP was 0.59, 0.61, and 0.62 for the 30-day composite and 0.64, 0.62, and 0.62 for the 90-day composite, respectively. Delta NT-proBNP clearly predicts short-term adverse cardiac events and is superior to baseline NT-proBNP, but similar to the 72 to 96 h NT-proBNP in predicting clinical events after STEMI. This likely reflects the variability in NT-proBNP at presentation and the ability to integrate subsequent important physiologic sequelae of STEMI such as reperfusion and infarct size.
机译：基线N末端脑钠肽（NT-proBNP）可用于急性ST段抬高型心肌梗塞（STEMI）的预后，但尚不清楚连续NT-proBNP，再灌注成功与预后之间是否存在关系。我们在招募了304例急性STEMI患者的WEST（一项早期ST抬高型心肌梗死治疗）试验中定义了NT-proBNP分析。在治疗前（n = 258）以及治疗后72至96 h（n = 247）和治疗后30天（n = 221）在基线时测量NT-proBNP（pg / mL）（Delta NT-proBNP = 72 h值-基线NT-proBNP）。再灌注成功是通过180分钟的ST段分辨力，前24小时内的峰值肌酸激酶（CK）和梗死时QRS评分（QRSd）来衡量的。主要终点是30天的临床综合治疗。使用单变量logistic回归和c统计量比较基线NT-proBNP或Delta NT-proBNP预测主要终点的能力。在基线时，以pg / mL计的NT-proBNP中位数（四分位数间距）为87（39-316），在72 h时为864（338-1857），在30天时为585（264-1212）。 ST分辨率与Delta NT-proBNP（r = -0.23，p = 0.002）和30天NT-proBNP（30天NT-proBNP 1016、828和397分别为<30％，30％-70％，>或分别等于或等于70％STR，p <0.001）。通过CK（r = 0.41，p <0.001）和QRSd（r = 0.31，p <0.001）将梗死面积与Delta NT-proBNP相关。 CK（r = 0.48，p <0.001）和QRSd（p = 0.003）的30天NT-proBNP关系相似。基线NT-proBNP与增加的30天综合终点（Q1，19％; Q2，20％; Q3，15％; Q4，38％; p = 0.03对于趋势）相关，Delta NT-proBNP（Q1 ，则为16％;第二季度为18％;第三季度为19％;第四季度为37％;趋势p = 0.009）。基线的72天至96小时的c统计量以及Delta NT-proBNP的30天复合物的c统计量分别为0.59、0.61和0.62，而90天复合物的c统计量分别为0.64、0.62和0.62。 Delta NT-proBNP清楚地预测了短期不良心脏事件，并且优于基线NT-proBNP，但在STEMI后的临床事件预测中与72-96 h NT-proBNP相似。这可能反映了NT-proBNP的变异性以及整合STEMI随后重要的生理后遗症（如再灌注和梗塞面积）的能力。

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