Prognostic Value Of CTtnI、hs-CRP And NT-proBNP For Left Ventricular Remodeling After ST-elevation Myocardial Infarction Treated With Selective Percutaneous Coronary Intervention

Background:Left ventricular remodeling (LVR) after myocardial infarction is related to congestive heart failure and death after acute myocardial infarction (AMI),which is the pathological process of congestive heart failure. So LVR could affect cardiac function and AMI prognosis. That infarction related artery is opened is key factor to suppress LVR. Currently in clinical practice, selective percutaneous coronary intervention (PCI) is the most common strategy which infarction related artery is opened for acute ST-segment elevation myocardial infarction (STEMI). It has been widely reported that the selective PCI can improve LVR and prognosis after STEMI. But the selective PCI cannot prevent LVR development in all patients with STEMI. Further research is warranted to investigate which types of STEMI patients benefit from the selective PCI. It is of clinically important significance for treatment selection and prognosis evaluation to identify the early risk factors of LVR development in STEMI patients.Objective:To explore the correlation between serum levels of cTnI, hs-CRP, and NT-proBNP and LVR development in STEMI patients underwent the selective PCI, and to evaluate the predictive value of serum cTnI, hs-CRP and NT-proBNP, therefore provide scientific evidence for prognosis of LVR development in STEMI patients undergoing selective PCI.Methods:Ninety six (96) patients, who had the first time STEMI and had selective PCI8to15days following STEMI. are enrolled. Scrum peak level of cTnI was obtained by analyzing cTnI at multiple timepoints within24hours post STEMI. Serum levels of NT-proBNP and hs-CRP were measured at24hours time point after STEMI. Left ventricular end-diastolic volumes were obtained using echocardiogram within3days and at6-month follow-up following STEMI. LVR was defined as≥20%increase in the left ventricular end-diastolic volume at6-month follow-up assessment as compared to that within3-day after STEMI.Results:Eighty five (85) out of96patients were followed for6months in the study. In the85patients,29patients had left ventricular end-diastolic volume increase≥20%, and were defined as the LVR group.The left56patients had left ventricular end-diastolic volume<20%, and were as assigned to the non-LVR (NLVR) group. Compared to non-LVR patients, LVR patients had higher levels of serum cTnI, hs-CRP, and NT-proBNP (P<0.05). Logistic regression analysis indicated that both serum peak level of cTnI and serum level of hs-CRP were associated with LVR and both cTnI and hs-CRP were identified as independent risk factors for LVR (OR=1.06, P<0.05; OR=1.20, P<0.05), while NT-proBNP had no correlation to LVR (P>0.05). Receiver operating characteristic (ROC) curve analysis for cTnI and hs-CRP showed that LVR patients had an area under the curve (AUC) of0.77and0.76, respectively (P<0.05), indicating that both serum peak cTnI and serum hs-CRP have good predictive value for late stage LVR. There were no differences in AUC between serum hs-CRP and peak cTnI (P>0.05), suggesting either has similar predictive accuracy. Receiver operating characteristic (ROC) curve analysis for cTnI and hs-CRP showed that LVR patients had sensibility of55.2%.58.6%, respectively.When serum hs-CRP and peak cTnI were combined together for predicting LVR, ROC curve analysis of the combination showed that LVR patients had an AUC of0.85(P<0.05) and sensibility of79.3%.There were significant differences in AUC (P<0.05) of serum hs-CRP and peak cTnl combination from that of either serum hs-CRP or peak cTnI alone. sensibility of serum hs-CRP and peak cTnI combination is higher than that of either serum hs-CRP or peak cTnI alone. Results suggested that the prognostic performance is improved by joint analysis of hs-CRP and peak cTnl.Conclusion:The serum levels of peak cTnI within24hours and hs-CRP at24hour post STEMI are independent predictor for LVR development in patients with STEMI underwent selective PCI, while24hour serum NT-proBNP level is not. Serum peak cTnI and hs-CRP have similar predictive accuracy,,and combination of serum peak cTnI and hs-CRP can improve the prediction power.