| Background and ObjectiveCoronary atherosclerotic heart disease(CHD)is caused by coronary atherosclerosis,which leads to myocardial cells deprived of oxygen and even myocardial necrosis,including chronic coronary artery disease and acute coronary syndrome(ACS),ACS includes unstable angina,non ST segment elevation acute myocardial infarction and ST-elevation acute myocardial infarction.With the abundance of human material life,the accelerating rhythm of life and the increasing of mental pressure,cardiovascular and cerebrovascular diseases have become one of the major threat to human health,due to patients with acute coronary syndrome(ACS)have high levels of cardiac mortality and other malignant complications such as heart failure,malignant arrhythmias,so people in the United States attaches great importance to identify acute coronary syndrome(ACS),each year,estimated 8 million acute coronary syndromes patients with non-traumatic chest pain were identified from the large chest pain patients after a medical assessment [1].Our predecessors identified patients with acute coronary syndrome based on their medical history and electrocardiogram results,it is not enough,with the improvement of medical technology,modern technologies such as myocardial enzymes,hypertroponin,and even myocardial nuclide gradually appeared,the diagnosis and treatment of acute coronary syndrome have a revolutionary progress,the detection rate of acute myocardial infarction increased significantly,with the popularity of emergency thrombolysis and PCI technology,acute myocardial infarction mortality declined obviously,but cardiac function and degree of coronary artery lesions are related to the prognosis of long-term,the diagnosis and treatment of cardiovascular disease is closely associated with biological markers,looking for a reliable biological markers for the diagnosis and treatment in patients with acute coronary syndrome is important.Many countries have followed a large number of clinical evidence for the development of clinical guidelines for disease,which plays a vital role in improving overall health care,however,there are constant reports suggesting that the guidelines are not recommended,to improve the application of guidelines in clinical practice,the American heart association launched Get With The Guidelines in 2001,more than 2,000 hospitals were involved,finally,the implementation of the clinical guidelines is greatly improved by the medical system,it’s a landmark in the United States.Under the supervision of the national health and family planning commission of our country,cardiovascular epidemiology branch of Chinese medical association(the Chinese Society of Cardiology,CSC)and the American heart association(AHA)collaborated "China cardiovascular disease medical quality improvement(CCC)project",the project continues to learn from the experience of The AHA-Get With The Guidelines.The project is co-sponsored by CSC and the AHA,the Beijing heart lung vascular disease institute is responsible for the implementation,our hospital was involved in the project in November 2014,in the process of collecting data,patients with acute myocardial infarction were found to have no apparent heart failure symptoms,there was no apparent abnormality in the left ventricular contraction and diastolic function,but NT-ProBNP is higher than normal,as is known to all,this is a biological marker that reflects cardiac function,the results were not consistent with the patient’s symptoms and the findings,according to the literature,NT-ProBNP is not only associated with the clear diagnosis,treatment effectiveness and long-term prognosis of heart failure patients,It also has different degrees of evolution in the course of cardiovascular disease such as angina and myocardial infarction[2],but the mechanism is unclear,the level of the NT-ProBNP was positively correlated with the size of the area of myocardial infarction and hypoxia[3-6],the link between cardiovascular disease and the neuroendocrine system continues to deepen,there is more and more evidence that NT-ProBNP is associated with ischemic heart disease[7],the increasing in secretion of NT-ProBNP can reflect the severity and prognosis of acute coronary syndrome,there are researchs that confirms that the hypoxia of myocardial cells is one of the factors that stimulates the synthesis of NT-ProBNP by ventricular muscle cells,the purpose of this study is to explore the relationship between the serum NT-ProBNP concentration and the degree of coronary disease,the number of lesions coronary artery and the LAD lesion in patients with acute myocardial infarction,in order to provide evidence for the clinical training and risk stratification of patients with acute myocardial infarction.Materials and methodsCollect eligible patients with STEMI,within 24 h after admission to detect the plasma NT-proBNP concentration,assess the degree of coronary disease based on the Gensini scoring system,divided into group A(< 30 points)and B(30 to 60 points),C(> 60 points),according to the number of coronary artery lesions are divided into single lesion group,the double lesions group and three lesions group,according to whether the criminal vascular is LAD divided into LAD group and non–LAD group,compare with the result of each group;Result1.The relationship between the severity of coronary artery disease and the plasma NT-ProBNP concentration: three groups of patients,age,sex,whether to have hypertension,creatinine,hemoglobin,fasting glucose,triglycerides,LVEF,ventricular septal thickness,and the internal diameter of the left ventricle has no statistically significant,plasma NT-ProBNP,diabetes,hemoglobin,total cholesterol,low density lipoprotein cholesterol has statistically significant,the concentration of plasma NT-proBNP GENSINI score > 60 is significantly higher than GENSINI score 30 to 60,GENSINI score 30 to 60 is significantly higher than the GENSINI score < 30,(P < 0.05);2.The relationship between the number of coronary lesions and the plasma NT-Pro BNP concentration: single,double and three lesions groups,statistical analysis showed age,smoking,whether suffering from high blood pressure,creatinine,hemoglobin,fasting blood sugar,triglyceride,low density lipoprotein cholesterol has no statistically significant difference,LVEF,interventricular septum thickness,left ventricular end-diastolic diameter with no statistically significant differences,with the increase of coronary lesion counts,NT-proBNP concentration increased significantly,the difference statistically significant(P < 0.05)3.The relationship between whether LAD is the criminal vascular and NT-ProBNP concentration: sex ratio,hypertension,creatinine,hemoglobin,fasting blood sugar,triglyceride,LVEF,interventricular septum thickness,left ventricular end-diastolic diameter difference is not significant,LAD group has a significantly higher concentration of plasma NT-proBNP,P < 0.05,the difference is statistically significant.4.Gesini integral and NT-proBNP concentration correlation analysis: draw the simple scatter diagram of the Gesini integral and NT-ProBNP concentration,and uneffective Pearson correlation analysis,the correlation coefficients of gesini integral and nt-probnp concentration(r = 0.278,P < 0.278)ConclusionThere is a positive correlation between the concentration of NT-proBNP and the severity of coronary artery in patients with STEMI with normal left ventricular ejection,NT-proBNP is of predictive value for the three vascular lesions and the LAD lesion,the routine monitoring of NT-ProBNP helps the early diagnosis,risk stratification and prognosis assessment of STEMI patients. |
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