The Influence Of Plasma N-terminal Brain Nartiuretic Peptide Precursor On The Prognosisof Acute Myocardial Infaction After Intravenous Thrombolysis

ObjectiveMyocardial infarction is a clinical common cardiovascular emergency. In recentyears，many studies have showed that plasma N amino-terminal pro-brain natriureticpeptide was significantly increased in heart failure and acute myocardial infarction，andsignificantly affected the prognosis of patients. How to evaluate the condition andprognosis of AMI，it has been one of the important issues facing the current clinicalmedicine. According to the guidelines revised by ACC/AHA and the Chinese medicalassociation，the main treatments for ST segment elevation myocardial infarction haveemergency percutaneous coronary angioplasty (PCI)，intravenous thrombolytic therapy.But in some junior hospital，they have disability for emergency PCI，intravenousthrombolytic is a useful therapy and an effective method for ST segment elevationmyocardial infarction. At present，the plasma N amino-terminal pro-brain natriureticpeptide was widely applied in more applications such as heart failure and acute myocardialinfarction. The report for diagnosis value of PCI in patients with postoperative clinicalsignificance was occasional. But it has not been to explore whether the earlycardiovascular events would be happened in patients with successful thrombolytic. Thedifferences between the two groups about NT-proBNP，and the relationship betweenNT-proBNP with serum troponin T，CK-MB，left ventricular ejection fraction，leftventricular end-diastolic volume，they have not been reported.The purpose of this studywas to observe whether early cardiovascular events occurred in patients with successfulthrombolysis to explore the differences between the two groups in NT-proBNP，and todetect its correlation with serum troponin T，CK，CK-MB，left ventricular ejection fraction，left ventricular end-diastolic volume，and discuss the value of plasma NT-proBNPfor severity and prognostic significance in the AMI patients with successful thrombolysis.Raterials and methodsThere were61AMI patients with successful intravenous thrombolysis，selectedfrom Internal Medicine-Cardiovascular department Dong’e county people’s hospital ofShan dong province，from Oct2009to June2012，including45males and16females，ageof from38to78years，average (62.41±9.408)years old. Including extensive anteriormyocardial infaction and anterior wall or anteroseptal wall (anterior wall group)26cases，inferior wall and or back wall right ventricular myocardial infaction (wall underthe group)35cases.The records of patients age，height, weight，total cholesterol，low-density lipoprotein，createne，urea nitrogen，blood sugar,troponin T and smokinghistory，hypertension，diabetes were writed down. We writed down the events aboutcardiovascular death，heart failure，recurrent myocardial infaction，post-infaction angianpectoris within30days after early intravenous thrombolysis. Before trements，we detectedall patients about NT-PRoBNP，D-dimer，eletrolyte，blood lipid series，blood sugar，liverfunction，renal function，infection immutity. All patients were made echocardiography onadmission. All patients after AMI were followed up for30days and observed whether earlycardiovascular events such as cardiovascular death，heart failure，recurrent myocardialinfaction，post-infaction angian pectoirs，ect. could occur. All the data were made statisticsanalysis with SPSSl9.0software. The results were expressed by mean±standarddeviation(x s). According to condition，two sample t-test and Pearson correlationanalysis were executed with P＜0.05for differences with a statistical significance. PlasmaBNP data are non-normal distribution. After the logarithmic transformation is normallydistributed. Bivariate correlation analysis were executed between serum CK，CK-MB，troponin T，LVEF，LVDD with NT-proBNP. All the mean±standard deviation and t-testare the results of NT-proBNP’s logscore.Results1.The plasma NT-proBNP level in early cardiovascular events occurred group wassignificantly higher than those no events group and the two groups have a significantdifference.2.The plasma NT-proBNP level was negatively correlated with left ventricularejection fraction. 3.The plasma NT-proBNP level was positively correlates with TnT(Troponin T) andcreatine kinase isoenzyme in patients with AMI4.The plasma NT-proBNP level was positively correlated with left ventricularend-diastolic diameter(LVEDD).5.The plasma NT-proBNP level was positively correlated with cardiac function.6.The plasma NT-proBNP level in anterior myocardial infarctionwas significantlyhigher than in inferior myocardial infarctionthat.Conclusion1.The plasma NT-proBNP level in early cardiovascular events occurred group wassignificantly higher than those no events group and the two groups have a significantdifference.2.The plasma NT-proBNP level was negatively correlated with left ventricularejection fraction. The plasma NT-proBNP level was positively correlated with creatinekinase，MB fractions of creatine kinase， troponin T，left ventricular end-diastolicdiameter.