178 - N-Terminal Pro-Brain Natriuretic Peptide and microvascular reperfusion after primary coronary angioplasty in acute myocardial infarction
Autor(s): S. Finazzi, G. Re, L. Filippini, E. Rossetti, M. Mariani, A. Bossi, M. Lotzniker
Issue: RIMeL - IJLaM, Vol. 4, N. 3, 2008 (MAF Servizi srl ed.)
Page(s): 178-183
Background. Several studies have shown that the patency of epicardial vessel does not guarantee optimal myocardial reperfusion in patients undergoing primary angioplasty (PTCA). The aim of the current study is to evaluate relationship between NT-proBNP, clinical and biochemical parameters, angiographic index of microvascular reperfusion and myocardial functional recovery at six mounths. Materials and Methods. The study takes in seventy eight patients with ST-segment elevation anterior acute myo- cardial infarction treated by successful PTCA. The magnitude of tissue perfusion after PTCA was evaluated by angiography using myocardial blush grade which is based on the contrast media intensity in the myocardium. NT-proBNP concentration was measured at baseline, 48 hours, 7 days and six months after PTCA together with left ventricular ejection fraction (EF). Basal and peak CK and cTnT were also evaluated. NT-proBNP, cTnT and CK were measured on serum samples using Modular PE analyser (Roche Diagnostics, Basilea, Switzeland) by ECLIA technology and IFCC standardization for CK. Results. Median value of NT-proBNP was always significantly lower in patients with normal MB except at admission. NT-proBNP valued at the seventh day shows better correlation with many prognostic parameters as age, time to reperfusion, multivessel disease, CK and cTnT peak. At univariate statistical analysis NTproBNP at 48 hours and 7 day are inversely related to EF at six mounths (OR 1.83, p= 0.004 e OR 1.62, p=0.007, 95% CI respectively); howewer MB show better performance both at univariate and multivariate analysis. Conclusions. Althought only MB grade gives independent information on recovery of left ventricular function at six months, easy biochemical evaluation with NT-proBNP at day 2 and 7 could be useful in the first weeks for confirme angiographic evaluation and could be considered an alternative method when MB is not evaluated in patients undergoing PTCA.