| Objective:Acute or chronic myocardial ischemia and hypoxia in patients of coronary artery disease(CAD) results in pathological cardiac remodeling characterized by ventricular wall dyskinesia(VWD), increasing of ventricular wall tension and high plasma BNP level,and at last result in major adverse cardiovascular events(MACE). Many researches have showed that plasma BNP concentration correlates well with severity of coronary artery disease(CAD),and plasma BNP level rises drastically in patients of acute myocardial infarction(AMI) and could predict clinical prognosis.We tried to analyze different clinical influencing factors including severity of coronary artery disease(CAD), old myocardial infarction(OMI), acute myocardial infarction(AMI), ventricular wall dyskinesia(VWD), percutaneous coronary intervention(PCI) history and so on. And we tried to confirm their correlation to plasma NT-proBNP. And further discuss clinical value of plasma NT-proBNP in prognostic prediction. Methods:In our research,we have selected 1225 CAD patients in cardiology department,NO.1 affiliated hospital of Nanjing Medical University. All patients had examined coronary angiography(CAG) and two dimensional echocardiogram(TDE),detected plasma NT-proBNP concentration routinely. And ventricular wall dyskinesia(VWD) were detected by TDE. The severity of coronary artery disease is estimated by CAG outcome referring to SYNTAX score system.We analyzed different influencing factors including PCI history, old myocardial infarction(OIM), acute myocardial infarction(AMI), VWD severity, sex, age, TG/HDL-c, hs-CRP, Glu and so on. And we tried to confirm the correlation between theses factors and plasma NT-proBNP of CAD patients, then we could discuss clinical value of plasma NT-proBNP level in CAD diagnosis and prognostic prediction. Outcome:Our clinic research shows for relatively stable CAD patients the severity of CAD(SCAD) referring to SYNTAX score system positively correlates with plasma NT-proBNP level,ORSCAD=2.383,P=0.011. And myocardial infarction also relate positively to plasma NT-proBNP level,with old myocardial infarction OROMI=2.836,P=0.007, with acute myocardial infarction ORAMI=4.501,P<0.001. And VWD particularly has a strongest relation to plasma NT-proBNP level,OR1=3.309,P=0.002;OR2=14.366,P< 0.001. Conclusions:Our research revealed that plasma NT-proBNP level of CAD patients correlate well with ventricular wall dyskinesia(VWD) in resting state,OMI,AMI,and PCI treatment. Plasma NT-proBNP concentration is especially sensitive indicator to severity of CAD and cardiac function. VWD in resting state which reveals poor prognosis for CAD patients has strongest relation to plasma NT-proBNP level. Persistent high plasma NT-proBNP(BNP) concentration hints terrible clinical prognosis.Objective:Plasma BNP level could sensitively reflect severity of CAD and extent of myocardial ischemia or hypoxia. High BNP level means high pressure of cardiac remodeling and predicts poor clinical prognosis. As we all know PCI treatment to acute myocardial infarction patients as early as possible could lower rate of myocardial infarction in the future and improve prognosis. Clinical researches show that admission BNP/NT-proBNP level of ACS patients is ideal biomarker for clinical prognosis. We have tried to evaluate benefits of PCI treatment in present China by detection of plasma NT-proBNP level and retrospective research to CAD patients including relatively stable CAD and myocardial infarction. Methods:In our research, we have selected 1225 CAD patients in cardiology department,NO.1 affiliated hospital of Nanjing Medical University. All patients had examined coronary angiography(CAG) and two dimensional echocardiogram(TDE),detected plasma NT-proBNP concentration routinely. And ventricular wall dyskinesia(VWD) were detected by TDE. The severity of coronary artery disease is estimated by latest CAG referring to SYNTAX score system.We analyzed different influencing factors including PCI history, old myocardial infarction, acute myocardial infarction, VWD severity, sex, age, LDL-c, TG/HDL-c, hs-CRP, Glu and so on. And we tried to confirm the correlation between theses factors to plasma NT-proBNP level of CAD patients. Then we could evaluate percutaneous coronary intervention(PCI) to CAD patients including including relatively stable CAD and myocardial infarction by plasma NT-proBNP level in Logistic multi-factor regression analysis. Outcome:Our research shows that PCI treatment could lower plasma NT-proBNP level in patients of myocardial infarction (OR=0.159,P=0.003), and more serious CAD patients including myocardial infarction with OR=0.308,P=0.003; But PCI intervention could not even reduce plasma NT-proBNP concentration in mild CAD patients including myocardial infarction (OR=1.101,P=0.913); And to relatively stable CAD patients, PCI intervention could lower NT-proBNP level without statistical significance (OR=0.504,P=0.141). Conclusions:Our retrospective clinical research preliminary shows that The more serious the CAD, the more clinical benefits PCI treatment could bring to reduce plasma NT-proBNP concentration. Patients of AMI have obtained most clinical benefits from PCI treatment, with most notable drop of BNP level. For AMI, effective and timely angiography and revascularization are crucial to optimal clinical outcomes especially for AMI of ST-segment-elevation. We should pay more attention to more early PCI treatment for AMI, minimize reperfusion time, reduce myocardial necrosis and improve prognosis. The research outcome do not support complete revascularization PCI treatment strategy. Stent implantation should be particularly cautious in mild CAD patients. And PCI treatment guided by FFR is preferred and could effectively avoid unnecessary stent implantation especially for intermediate coronary disease.
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