The Comparison Of Clinical Prognosis In Different Age Patients With ACS After Interventional Treatment By Plasma BNP

[0bjective]To investigate and compare the clinical prognostic value of major abnormal cardiac events (MACE) in different age groups of acute coronary syndrome (ACS) patients after percutaneous coronary intervention (PCI )by plasma B-type natriuretic peptide (BNP)[Methods]Retrospective analysis 418 cases of ACS patients with PCI in our hospital from December 2007 to March 2010,which were divided into two groups ,one included 301 patients≥60 years old and the other included 117 patients<60 years old,All that admitted to hospital routine testing BNP were divided into≤80pg/ml group of 157 patients and >80pg/ml group of 261 patients according to BNP evels .To measure BNP within 24h symptom onset and follow-up major abnormal cardiac events(including death,cardiogenic shock, recurrent angina pectoris, non-fatal re-infarction, non-fatal heart failure,arrhythmia, target vessel revascularization, re-admitted to hospital composite end point) during hospitalization, within 6 months after discharge from hospital.[Results]301 patients whose ages were≥60 years old were followed up and 6 cases were lost (1.9%); 107 patients whose ages were < 60 years old were followed up and 2 cases were lost (1.7%).1,BNP of 295 patients≥60 years old was averge(610.16±946.37) pg / ml, 34 patients (11.5%) occurred all-cause mortality . of which 161 STEMI patients died 25 patients (15.5%), 63 NSTEMI patients died 8 patients (12.7%), 71 UA patients were 1 death (1.4%);There were 177 times non-fatal MACE, in which 203 patients with BNP> 80pg /ml occurred 157 times, 92 patients with BNP≤80pg /ml occurred 20 times. In 115 cases of <60-year-old patients, BNP was average (242.19±553.79) pg / ml, all-cause mortality occurred in 2 cases (1.7%); There were non-fatal MACE 46 (times), in which 54 patients with BNP> 80pg / ml occurred 39 times, 61 cases of patients with BNP≤80pg /ml occured 7 times.The results of different age groups patients showed that the difference was statistically significant (P <0.01).2,In both groups≥60 years old and <60-year-old, MACE times of patients with BNP> 80 pg /ml were significantly higher than MACE times of patients with BNP≤80 pg /ml, the difference was statistically significant (P <0.01).3,In both groups≥60 years old and <60-year-old, BNP levels of patients with coronary artery multivessel disease , regional wall motion abnormalities by echocardiography, LVEF<50% and died patients compared with BNP levels of patients with single vessel disease,regional wall motion normal, LVEF≥50% and survivors, the difference was statistically significant (P <0.01).4,BNP levels in patients≥60 years old was positively correlated with age (r = 0.313, P <0.01), BNP levels were negatively correlated with LVEF (r =- 0.125, P = 0. 031 <0.05). While BNP levels in patients<60 years old was no correlation with age (r = 0.005, P = 0.959), BNP levels were negatively correlated with LVEF (r =- 0.348, P <0.01).5,Multiple factors logistic regression analysis results in≥60 years old patients showed that BNP could independently predict MACE incidence during hospitalization and within 6 moths after discharge from hospital(OR = 5.791,95% CI: 3.231 ~ 10.351, P <0.01),while the BNP (OR = 5.355,95% CI: 1.217 ~ 23.557, P <0.01) and age (OR = 2.386,95% CI: 1.378 ~ 4.131, P <0.01) were independent predictors of mortality of elderly patients with ACS after PCI during hospitalization and within 6 moths after discharge from hospital, Multiple factors logistic regression analysis results in<60-year-old patients showed that, BNP could independently predict MACE incidence during hospitalization and within 6 moths after discharge from hospital (OR = 6.662,95% CI: 2.492 ~ 17.809, P <0.01).6,ROC curves in patients≥60 years showed that BNP levels predicted MACE was significant (P <0.01), the higher BNP level was, the greater the possibility of MACE occurrence; BNP levels predicted mortality was significant (P <0.01), the higher BNP level was, the higher of mortality of eldly ACS paitiets after PCI.ROC curves in<60-year-old patients showed that: BNP levels predicted MACE was significant (P <0.01), the higher BNP level was, the greater the possibility of MACE occurrence. The MACE results predicted by the ROC curves of patients in different age groups showed that the difference was statistically significant (P <0.01).[Conclusion]This clinical study results show that BNP can be a good independent short-term predictor of ACS patients after PCI , but the prognosis significance patients with different age are difference, BNP are worth more against major abnormal cardiac events of elderly ACS patients after PCI.