Turk Kardiyol Dern Ars. 2011; 39(7): 540-548 | DOI: 10.5543/tkda.2011.01610

In-hospital prognostic value of admission plasma B-type natriuretic peptide levels in patients undergoing primary angioplasty for acute ST-elevation myocardial infarction

Vecih Oduncu¹, Ayhan Erkol², Ali Cevat Tanalp³, Cihan Dündar¹, İbrahim Halil Tanboga⁴, Dicle Sırma⁵, Ali Karagöz¹, Can Yücel Karabay¹, Akın İzgi¹, Selçuk Pala¹, Kürşat Tigen¹, Cevat Kırma^1
1Department of Cardiology, Kartal Kosuyolu Heart Education And Research Hospital, Istanbul, Turkey
²Department of Cardiology, Kocaeli Derince Education And Research Hospital, Kocaeli, Turkey
³Department of Cardiology, Medicana International Hospital, Ankara, Turkey
⁴Department of Cardiology, Erzurum Education And Research Hospital, Erzurum, Turkey
⁵Department of Cardiology, Siirt State Hospital, Siirt, Turkey

OBJECTIVES
We assessed in-hospital prognostic value of admission plasma B-type natriuretic peptide (BNP) levels in patients undergoing primary percutaneous coronary intervention (p-PCI) for acute ST-elevation myocardial infarction (STEMI).

STUDY DESIGN
In a retrospective design, we evaluated 992 patients (801 males, 191 females; mean age 56±12 years) treated with p-PCI for STEMI. The patients were divided into two groups according to the admission BNP levels, taking the cut-off value of BNP as 100 pg/ml; i.e, ≥100 pg/ml (n=334, 33.7%) and <100 pg/ml (n=658, 66.3%). Postprocedural angiographic and clinical in-hospital results were recorded.

RESULTS
No-reflow (24% vs. 9%), heart failure (32.3% vs. 5.5%) and death (15.6% vs. 1.7%) were significantly more common in patients with BNP ≥100 pg/ml (p<0.001). In multivariate analysis, elevated baseline BNP level was identified as an independent predictor of no-reflow (OR=1.83; 95% CI 1.22-2.74, p=0.003), acute heart failure (OR=2.67; 95% CI 1.55-4.58, p<0.001), and in-hospital mortality (OR=3.28; 95% CI 1.51-7.14, p=0.003). In receiver operating characteristic curve analysis, the area under the curve and sensitivity/specificity of the cut-off value of BNP (100 pg/ml) for prediction of clinical endpoints were 0.741 and 58.6%/70.3% for no-reflow, 0.822 and 75%/73.3% for heart failure, and 0.833 and 82.5%/69.4% for death, respectively (p<0.001 for all).

CONCLUSION
Elevated admission BNP level is an independent predictor of angiographic no-reflow, acute heart failure, and mortality in STEMI patients during in-hospital period, suggesting that it might be incorporated into traditional risk scoring systems to improve early risk stratification.

Keywords: Angioplasty, balloon, coronary, coronary angiography; myocardial infarction; natriuretic peptide, brain; prognosis; risk assessment

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