| Objective:This study was to explore early revascularization the level of BNP and the relationship between the level of BNP and the prognosis of patient with AMI and to investigate the relation between prophase plasma N-terminal pro-B-type natriuretic peptide(NT-proBNP) and other factors such as endotheline-1(ET-1) angiotensinⅡand theirs effect in left ventricular remodeling with acute anterior myocardial infarction.And also the affect on all above factors of early revascularization which effect the cardial fuction and LVRM.Methods:First,to select 112 patients with AMI for the first time that were admitted in Tianjin Chest hospital from Jan.1st 2004 to Dec.31st 2004,including 74 male patients and 38 female patients.From 36 to 88 years(62.8±12.6) years. The levels of plasma BNP were measured at admission at 24 hours and at 14 days after admission.All patients undergoing percutaneous coronary intervention(PCI) in 13 hours,according to the status of infarct related artery within 6 hours whom were devided into 6-hour patency group and 6-hour occluded group.And echocardiography was performed within 7 days after admission in all patients,recorded left ventricular end-diastolic volume index(LVEDVI) and left ventricular jection fraction(LVEF).Followed-up every patient who was chosen for 24 monthes,recorded clinical terminal events.Second,to select 107 patients with acute anterior myocardial infarction for the first time that were admitted in our hospital from Jan.1st 2004 to Jun 30th 2005, including 72 male patients and 35 female patients.(63.7±10.1) years.The levels of plasma NT-proBNP ET-1 andAngll were measured at 24 hours after admission and echocardiography with left ventricular end-diastolic diameter(LVEDVI) and left ventricular ejection fraction(LVEF)were performed in all patients at within 7days and at 30days after admission.The infarct related artery of all patients were patent within 13 hours,although some of them were performed after 6 hours.They were grouped into two groups;6-hour patency group and 6-hour occluded group.To prepare the relation between plasma NT-proBNP ET-1 and Angll and the affect on LVRM.Results:The levels of BNP at admission were no difference in the two groups,but at 24 hours and 14 days the levels of 6-hour occluded group were significantly higher(P＜0.001).Take 350pg/ml(BNP2) as cut-off,the portion of 6-hour occluded group was large(P＜0.001).The levels of BNP in three points had positive correlation with LVEDVI CK CK-MB cTnl(P＜0.01),but had negative correlaton with LVEF(P＜0.01).The survival rates with no events of two years in the two groups were 85.51%and 62.79%(P=0.001).The survive curve of 6-hour occluded group were lower than 6-hour patency group,especially in patients of high BNP(＞350pg/ml).NT-proBNP in 24 hour after onset had satisfactory dependability with LVEF of admission and 1 month after onset,their coefficient correlation were r=-0.333 (P?.0001) r=-0.408(P＜0.001),respectively.as well had satisfactory dependability with LVEDVI and ALVEDVI.In 6-hour patency group their AngⅡlevel were significant lower than 6-hour occlusion.(48.48±29.35vs 78.83±51.66,pg/L, p=0.01).The level of Angll had satisfactory dependability with LVEF,LVEDVI at admission and at 1 month after onset but had no denpendence with A LVEDVI.In 6-hour patency group their ET-1 had the same change(0.50±0.29 vs 0.86±0.54, ng/L,p＜0.001).Conclusion:The levels of BNP was an independent risk factor in the infaust prognosis of acute myocardial infarction.Moreover the importance of early revascularization may also be supported with BNP kinetics in maintaining left ventricular function and improving prognosis.Plasma NT-proBNP in 24 hour after acute anterior myocardial infarction had relation with heart function in the future and LVRM.To patent the infarct-related artery prophase may derease NT-proBNP,ET-1 and Angll,and had profit to heart function and LVRM.NT-proBNP,ET-1,Angll had dependability eath other,they all affect LVRM after AMI.
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