Comparison of the Usefulness of N-Terminal Pro-Brain Natriuretic Peptide to Other Serum Biomarkers as an Early Predictor of ST-Segment Recovery After Primary Percutaneous Coronary Intervention

Niels J. W. Verouden, Joost D. E. Haeck, Wichert J. Kuijt, Nan van Geloven, Karel T. Koch, José P. S. Henriques, Jan Baan, Marije M. Vis, Jan P. van Straalen, Johan Fischer, Jan J. Piek, Jan G. P. Tijssen, Robbert J. de Winter

Research output: Contribution to journalArticleAcademicpeer-review

12 Citations (Scopus)

Abstract

Data on the ability of serum biomarkers to predict microvascular obstruction by ST-segment recovery after primary percutaneous coronary intervention (PCI) is largely absent. Therefore, we determined the association between 5 serum biomarkers, obtained before emergency coronary angiography, and immediate ST-segment recovery in patients who had undergone primary PCI for ST-segment elevation myocardial infarction. We measured N-terminal pro-brain natriuretic peptide (NT-pro-BNP), cardiac troponin T, creatinine kinase-MB fraction, high-sensitivity C-reactive protein, and serum creatinine from blood samples obtained through the arterial sheath at the start of primary PCI. Serial 12-lead electrocardiograms were recorded in the catheterization laboratory before arterial puncture and at the end of the PCI. ST-segment recovery was defined as incomplete if <50% Of 662 included patients with ST-segment elevation myocardial infarction, 338 (51%) had incomplete ST-segment recovery. An elevated NT-pro-BNP level (>= 608 ng/L) was the strongest predictor of incomplete ST-segment recovery (adjusted odds ratio 2.6, 95% confidence interval 1.6 to 4.1; p <0.001) compared to other serum biomarkers and clinical predictors. An elevated NT-pro-BNP level was more strongly predictive in patients without a history of coronary artery disease or hypertension (adjusted odds ratio 4.7, 95% confidence interval 2.4 to 9.2; p <0.001). NT-pro-BNP was the best contributor to both net reclassification (0.43; p <0.001) and integrated discrimination improvement (0.04; p <0.001) when added to a multivariate model with clinical predictors of incomplete ST-segment recovery. In conclusion, NT-pro-BNP was the strongest independent predictor of ST-segment recovery at the end of primary PCI for ST-segment elevation myocardial infarction compared to the other serum biomarkers reflecting myocardial cell damage, renal function, and inflammation. (C) 2010 Elsevier Inc. All rights reserved. (Am J Cardiol 2010;105:1047-1052)
Original languageEnglish
Pages (from-to)1047-1052
JournalAmerican Journal of Cardiology
Volume105
Issue number8
DOIs
Publication statusPublished - 2010

Cite this