| 이준원¹, 윤영진² , 성중경³ , 안성균⁴ , 김장영5 , 유병수6 , 이승환7 , 윤정한8 , 최경훈9 |
Background and purpose: B-type natriuretic peptide (BNP) is known as an independent predictor of clinical outcome in patients with acute myocardial infarction (AMI). The elevated levels of BNP during early remodeling phase (BNPr) predict magnitude of subsequent left ventricular (LV) dilatation and maladaptive LV remodeling. We determined the association between clinical outcome and the elevated levels of BNP during late remodeling phase (< 4 week).
Methods: Of 972 patients from WOnju christian hospital Myocardial Infarction database Registry (WOMIR) from March 2003 to January 2009, we analyzed 698 patients (mean 62.0 ± 12.1 years old, male 64.6%) who underwent percutaneous coronary intervention. BNP was measured at initial (BNPi) and within one month (BNPr) by quantitative immunofluorescence assay (Triage®, Biosite, San Diego, UA). We assessed the prognostic value for BNPi and BNP-R as well as other clinical factors for all-cause of death.
Results:
1. During follow-up (mean 844 ± 576 days), 52 patients died including in- or out of hospital. Mean BNPi was 181.8 ± 447.2 pg/mL and mean BNPr was 223.4 ± 520.4 pg/mL. In ROC curves, The AUC for BNPi, BNPr, CRP, peak Troponin I level for the prediction of all cause of death are 0.776 (p<0.001), 0.824 (p<0.001), 0.660 (p<0.001), 0.598 (0.026), respectively. BNPr showed a sensitivity of 71.2% and a specificity of 74.5% under a cut-off value of 130.3 pg/ml.
2. High BNPr group with the level ≥ 130.3 pg/mL (n=202) had older age (67.6 ± 11.2 vs. 59.4 ± 11.6 years old, p<0.001), lower left ventricle ejection fraction (44.9 ± 12.3 vs. 50.7 ± 11.9 %, p<0.001), advanced Killip score (>3) (26.9 vs. 10.1%, p<0.001), higher mortality rate (18.3 vs. 3.0 %, p<0.001).
3. By multiple logistic regression analysis, Log-BNPr was most powerful predictive maker for death and had more prognostic value for all-cause of death than Log-BNPi (OR 2.02, 95% CI 1.48 to 2.78, p<0.001 vs. OR 1.57, 95% CI 1.15 to 2.15, p=0.004, respectively).
Conclusions: Our findings suggest that BNP might be helpful in the risk stratification. Moreover, BNP level during late remodeling phase is a more potent independent predictor for mortality than initial BNP level in patients with AMI underwent percutaneous coronary intervention.
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