Predictive Value Of Serum N-terminal Pro-Brain Natriuretic Peptide On Admission In Patients With Acute Myocardial Infarction On ST Segment Resolution After Primary Percutaneous Coronary Intervention

Objective:To evaluate the prediction of serum N-terminal pro-Brain natriuretic peptide (NT-proBNP) on admission in patients with acute STEMI on ST segment resolution (STR) after primary percutaneous coronary intervention (pPCI) so as to identify STEMI patients at a high risk of incomplete STR. Then agressive and upstream measures will be made for those patients ahead of pPCI in order to improve clinical outcomes.Methods:218 consective STEMI patients,who underwent pPCI between January 2010 and December 2012 in two hospitals(Renmin hospital of Wuhan University and the first pepole's hospital of Chenzhou) were enrolled in the study. Patients were divided into STR group (STR?50%) and Non-STR group (STR<50%) according to STR ratio on electrocardiogram (ECG) at 180 minutes after pPCI. Within a follow-up for12 months, major adverse cardiac events(MACE) were observed.Baseline clinical characteristics,datas related to procedure of pPCI,biochemical items, cardiac markers,were compared between two groups.Predictive factors of Non-STR will be identified by means of univariate analysis, multivariate logistic regression analysis, receiver operating characteristic (ROC) curve analysis and so forth.Results:STR at 180 minutes after pPCI occurred in 202 Patients (92.7%),inversely,the prevalence of Non-STR accounted for 7.3%(16 Patients).In contrast with STR group, univariate analysis showed patients in Non-STR group had lower left ventricular ejection fraction (LVEF) [(56.5±3.0%) vs(58.7%±3.6)%;P=0.019], larger left ventricular end-diastolicdimension(LVEDD)[(53.1±2.7) mm vs (50.6±2.9) mm;P =0.019],higher glycosylated hemoglobin (HBA1C) [(6.9%±2.1%) vs (5.6%±1.3%);P=0.034] and NT-ProBNP [(4476.2±1784.9)pg/ml vs(2505.6±1638.4) pg/ml;P<0.001].Multivariate logistic regression analysis indicated, high serum NT-proBNP level on admission in patients with STEMI was an only independent predictive factor of Non-STRafter pPCI(adjusted odds ratio 3.368,95% CI:3.152 to 4.643;P=0.004).The area under the ROC curve for NT-proBNP was 0.814.A NT-proBNP concentration?2563.6pg/ml had a sensitivity of 81.2% and a specificity of 65.8% respectively.Conclusions:Serum NT-proBNP on admission in patients with STEMI had great predictive value on Non-STR after pPCI. NT-proBNP-guided approach may be useful in identifying STEMI patients with a high risk of Non-STR and provide more benefical information for physicians prior to pPCI.