natriuretic-peptide--brain and ST-Elevation-Myocardial-Infarction

The role of Sodium-glucose co-transporter 2 inhibitors (SGLT2i) in heart failure is established. Early data also suggests their favorable role in patients with acute coronary syndromes, but more evidence is still needed.. In this dual center, double-blinded randomized controlled trial, non-diabetic patients (N = 100) who presented with anterior ST- elevation myocardial infarction (STEMI) & had undergone successful primary percutaneous coronary intervention, but their left ventricular ejection fraction was below 50%, were randomized to dapagliflozin 10 mg or a placebo once daily. The primary endpoint was a change in cardiac function assessed by N-terminal pro-Brain Natriuretic Peptide - NT-proBNP measured at baseline & 12 weeks post the cardiac event &/or echocardiographic parameters (left ventricular ejection fraction, left ventricular diastolic dimension & left ventricular mass index) assessed at baseline, 4-weeks & 12-weeks post the cardiac event.. From October 2021 to April 2022, 100 patients were randomized. The mean drop of NT- proBNP in the study group was more significant compared to the control group by 10.17% (95% CI: -3.28-19.67, p-value 0.034). In addition, the decrease in the left ventricular mass index (LV mass index) was also significant in the study group compared to the control group by 11.46% (95% CI: -19.37 to -3.56, p-value 0.029).. Dapagliflozin seems to have a role in preventing left ventricular dysfunction & maintaining cardiac function following anterior ST-elevation myocardial infarction. More Large-scale trials need to be done to confirm these findings further. This trial is locally registered at the National Heart Institute, Cairo - Egypt, and Faculty of Medicine, Ain Shams University, with reference numbers CTN1012021 & MS-07/2022, respectively. It is also registered retrospectively at the US National Institutes of Health (ClinicalTrial.gov) with identifier number: NCT05424315 - June 16th,2022.

Topics: Anterior Wall Myocardial Infarction; Biomarkers; Humans; Myocardial Infarction; Natriuretic Peptide, Brain; Peptide Fragments; Retrospective Studies; ST Elevation Myocardial Infarction; Stroke Volume; Ventricular Function, Left

The aim of this study was to investigate the effect of recombinant human B-type natriuretic peptide (rhBNP) on improving ventricular function in patients with ST-elevation myocardial infarction (STEMI).. In this retrospective study, 96 patients with STEMI admitted to Cangzhou Central Hospital from June 2017 to June 2019 were recruited and randomized to either a control group or an experimental group, with 48 patients in each group. Patients in both groups were given conventional pharmacological therapy, and an emergency coronary intervention was performed within 12 hours. Patients in the experimental group received rhBNP intravenously postoperatively, whereas patients in the control group received an equal amount of 0.9% NaCl solution through an intravenous drip. Postoperative recovery indicators were compared between the two groups.. Patients treated with rhBNP showed better postoperative respiratory frequency, heart rate, blood oxygen saturation, pleural effusion, acute left heart remodeling after surgery and central venous pressure at 1-3 days after surgery than those without (p<0.05). Early diastolic blood flow velocity/early diastolic motion velocity (E/Em) and wall-motion score indices (WMSI) of patients in the experimental group were markedly lower compared to the control group one week after surgery (p<0.05). Patients receiving rhBNP had better left ventricular ejection fraction (LVEF) and WMSI six months after surgery and higher left ventricular end diastolic volume (LVEDV) and LVEF one week after surgery than the controls (p<0.05). Administration of rhBNP for patients with STMI provided a higher treatment safety by significantly reducing the incidence of left ventricular remodeling and complication than conventional medication (p<0.05).. Intervention with rhBNP in STEMI patients could effectively inhibit ventricular remodeling, alleviate symptoms, reduce adverse complications and improve ventricular function.

Topics: Humans; Natriuretic Peptide, Brain; Percutaneous Coronary Intervention; Retrospective Studies; ST Elevation Myocardial Infarction; Stroke Volume; Ventricular Function; Ventricular Function, Left; Ventricular Remodeling

Circulating ketone bodies (KBs) are increased in patients with heart failure (HF), corresponding with increased cardiac KB metabolism and HF severity. However, the role of circulating KBs in ischemia/reperfusion remains unknown.. This study sought to investigate longitudinal changes of KBs and their associations with functional outcomes in patients presenting with ST-segment elevation myocardial infarction (STEMI).. KBs were measured in 369 participants from a randomized trial on early metformin therapy after STEMI. Nonfasting plasma concentrations of KBs (β-hydroxybutyrate, acetoacetate, and acetone) were measured by nuclear magnetic resonance spectroscopy at presentation, at 24 hours, and after 4 months. Myocardial infarct size and left ventricular ejection fraction (LVEF) were determined by cardiac magnetic resonance imaging at 4 months. Associations of circulating KBs with infarct size and LVEF were determined using multivariable linear regression analyses.. Circulating KBs were high at presentation with STEMI (median total KBs: 520 μmol/L; interquartile range [IQR]: 315-997 μmol/L). At 24 hours after reperfusion, KBs were still high compared with levels at 4-month follow-up (206 μmol/L [IQR: 174-246] vs 166 μmol/L [IQR: 143-201], respectively; P < 0.001). Increased KB concentrations at 24 hours were independently associated with larger myocardial infarct size (total KBs, per 100 μmol/L: β = 1.56; 95% confidence interval: 0.29-2.83; P = 0.016) and lower LVEF (β = -1.78; 95% CI: (-3.17 to -0.39; P = 0.012).. Circulating KBs are increased in patients presenting with STEMI. Higher KBs at 24 hours are associated with functional outcomes after STEMI, which suggests a potential role for ketone metabolism in response to myocardial ischemia. (Metabolic Modulation With Metformin to Reduce Heart Failure After Acute Myocardial Infarction: Glycometabolic Intervention as Adjunct to Primary Coronary Intervention in ST Elevation Myocardial Infarction (GIPS-III): a Randomized Controlled Trial; NCT01217307).

Topics: Aged; Biomarkers; Female; Humans; Hypoglycemic Agents; Ketone Bodies; Male; Metformin; Middle Aged; Myocardium; Natriuretic Peptide, Brain; Peptide Fragments; Recovery of Function; ST Elevation Myocardial Infarction; Stroke Volume

B-type natriuretic peptide (BNP) has favourable effects on left ventricular remodelling, including antifibrotic and antiapoptotic properties. We tested the hypothesis that infusion of BNP after an acute myocardial infarction would reduce left ventricular systolic and diastolic volumes and improve left ventricular ejection fraction compared with placebo.. A total of 58 patients who underwent successful revascularisation for an acute ST elevation anterior myocardial infarction were randomised to receive 72-hour infusion of BNP at 0.006 µg/kg/min or placebo. Left ventricular end diastolic and systolic volumes and left ventricular ejection fraction were measured at baseline and at 30 days by multigated acquisition scan. Left ventricular infarction size was measured by cardiac MRI.. BNP infusion led to significantly higher BNP levels and plasma cyclic guanosine monophosphate at 72 hours. No significant difference in change of left ventricular volumes or ejection fraction from baseline to 30 days was observed between groups. Although left ventricular infarction size measured by cardiac MRI was not significantly different between BNP infusion versus placebo (p=0.39), there was a trend towards reduced infarction size in patients with a baseline ejection fraction of <40% (p=0.14).. Infusion of BNP in patients with an anterior myocardial infarction did not affect parameters of left ventricular remodelling. Patients treated with BNP who had a baseline left ventricular ejection fraction of <40% had a trend towards reduced left ventricular infarction size compared with placebo. These results do not support the use of intravenous BNP in patients after recent myocardial infarction.. NCT00573144.

Topics: Double-Blind Method; Guanosine Monophosphate; Heart Ventricles; Humans; Infusions, Intravenous; Magnetic Resonance Imaging, Cine; Myocardial Revascularization; Natriuretic Agents; Natriuretic Peptide, Brain; ST Elevation Myocardial Infarction; Stroke Volume; Ventricular Remodeling

N-terminal fragment of the brain natriuretic peptide prohormone (NT-proBNP), a marker for neurohumoral activation, has been associated with adverse outcome in patients with myocardial infarction. NT-proBNP levels may reflect extensive ischemia and microvascular damage, therefore we investigated the potential association between baseline NT-proBNP level and ST-resolution (STR), a marker of myocardial reperfusion, after primary percutaneous coronary intervention (pPCI).. we performed a post-hoc analysis of the On-TIME II trial (which randomized ST-elevation myocardial infarction (STEMI) patients to pre-hospital tirofiban administration vs placebo). Patients with measured NT-proBNP before angiography were included. Multivariate logistic-regression analyses was performed to investigate the association between baseline NTproBNP level and STR one hour after pPCI.. Out of 984 STEMI patients, 918 (93.3%) had NT-proBNP values at baseline. Patients with STR <70% had higher NT-proBNP values compared to patients with complete STR (>70%) [Mean ±SD 375.2 ±1021.7 vs 1007.4 ±2842.3, Median (IQR) 111.7 (58.4-280.0) vs 168.0 (62.3-601.3), P <.001]. At multivariate logistic regression analysis, independent predictors associated with higher risk of poor myocardial reperfusion (STR <70%) were: NT-proBNP (OR 1.17, 95%CI 1.04-1.31, P = .009), diabetes mellitus (OR 1.87, 95%CI 1.14-3.07, P = .013), anterior infarct location (OR 2.74, 95% CI 2.00-3.77, P <.001), time to intervention (OR 1.06, 95%CI 1.01-1.11, P = .021), randomisation to placebo (OR 1.45, 95%CI 1.05-1.99, P = .022).. In STEMI patients, higher baseline NT-proBNP level was independently associate with higher risk of poor myocardial reperfusion, supporting the potential use of NT-proBNP as an early marker for risk stratification of myocardial reperfusion after pPCI in STEMI patients.

Topics: Adult; Aged; Aged, 80 and over; Anterior Wall Myocardial Infarction; Biomarkers; Diabetes Mellitus; Double-Blind Method; Female; Fibrinolytic Agents; Humans; Male; Middle Aged; Myocardial Reperfusion; Natriuretic Peptide, Brain; Peptide Fragments; Percutaneous Coronary Intervention; Prospective Studies; Regression Analysis; ST Elevation Myocardial Infarction; Time-to-Treatment; Tirofiban; Young Adult

Myocardial injury of ST-segment elevation myocardial infarction (STEMI) initiates an intense inflammatory response that contributes to further damage and is a predictor of increased risk of death or heart failure (HF). Interleukin-1 (IL-1) is a key mediator of local and systemic inflammatory response to myocardial damage. We postulate that the use of the drug RPH-104, which selectively binds and inactivates both α and β isoforms of IL-1 will lead to a decrease in the severity of the inflammatory response which will be reflected by decrease in the concentration of hsCRP, as well as the rate of fatal outcomes, frequency of new cases of HF, changes in levels of brain natriuretic peptide (BNP) and changes in structural and functional echocardiographic parameters.. This is a double blind, randomized, placebo-controlled study in which 102 patients with STEMI will receive a single administration of RPH-104 80 mg, RPH-104 160 mg or placebo (1:1:1). The primary endpoint will be hsCRP area under curve (AUC) from day 1 until day 14. Secondary endpoints will include hsCRP AUC from day 1 until day 28, rate of fatal outcomes, hospitalizations due to HF and other cardiac and non-cardiac reasons during 12-month follow-up period, frequency of new cases of HF, changes in levels of brain natriuretic peptide (BNP, NT-pro-BNP), changes in structural and functional echocardiographic parameters during 12-month follow-up period compared to baseline. The study started in October 2020 and is anticipated to end in 2Q 2022.. ClinicalTrials.gov, NCT04463251. Registered on July 9, 2020.

Topics: Biomarkers; C-Reactive Protein; Echocardiography; Heart Failure; Humans; Interleukin-1; Natriuretic Peptide, Brain; ST Elevation Myocardial Infarction

To conduct a randomized double-blind prospective study to investigate effect of different doses of atorvastatin, rosuvastatin, and simvastatin on elderly patients with ST-elevation AMI after PCI.. One hundred and ninety-two AMI patients over 60 years old who underwent PCI were randomly divided into six groups: the low atorvastatin group, high atorvastatin group; low rosuvastatin group; high rosuvastatin group; low simvastatin group; high simvastatin group. Demographic data and clinical information as well as coronary angiography parameters were recorded. Plasma levels of CK-MB, BNP, ALT, and TnI were measured at 12 hr, 24 hr, and 1 week after PCI. Major cardiovascular events (MACE) were recorded and analyzed using Kaplan-Meier (K-M) curve.. No significant differences were observed in angiographic and procedural characteristics. In all high dose groups, all levels of CK-MB, BNP, ALT, and TnI were significantly lower. However, after 1 week of PCI, only CK-MB, BNP, and TnI showed significant difference between high and low dose groups. Patients in high dose groups had significantly lower rates for surgical or percutaneous intervention, recurrence of angina, and rehospitalization. K-M curve analysis also showed cumulative incidence freedom time of overall MACE in high dose groups was significantly longer. No significant differences were found among different drugs with the same doses.. Patients with higher doses had lower level of CK-MB, BNP, ALT, and TnI and lower occurrence of MACE after PCI.

Topics: Aged; Aged, 80 and over; Alanine Transaminase; Atorvastatin; Cholesterol; Coronary Angiography; Creatine Kinase, MB Form; Double-Blind Method; Female; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Male; Middle Aged; Natriuretic Peptide, Brain; Percutaneous Coronary Intervention; Rosuvastatin Calcium; Simvastatin; ST Elevation Myocardial Infarction; Troponin I

Soluble suppression of tumorigenicity 2 (sST2), a biomarker representing myocardial fibrosis and inflammation, has been applied in risk stratification of patients with myocardial infarction (MI). However, whether primary PCI (PPCI) will eliminate the predictive value of sST2 in STEMI patients has not been well studied. Here, we conducted a prospective clinical trial to evaluate the correlation between sST2 and prognosis in STEMI patients undergoing PPCI. sST2 levels were measured in 295 STEMI patients (60.2 ± 10.8 years) at admission using a high sensitivity assay. Baseline sST2 levels were significantly associated with heart function, biomarkers of inflammation, and myocardial injury. During a 12-month follow-up, 19 patients had major adverse cardiovascular events (MACEs). Greater sST2 was continuously associated with a higher risk of incident MACEs. Such association remained even after adjusting for other risk factors in a multivariate Cox analysis. A baseline sST2 level in the highest quartile (≥ 58.7 ng/mL) was independently associated with mortality (HR: 5.01, 95%CI: 1.02-16.30, P = 0.048). More incident heart failure was seen in the group with greater sST2, however, the association was not significant after adjustment. Therefore, baseline sST2 may be useful to predict MACEs, especially mortality, in STEMI patients receiving PPCI.

Topics: Aged; Biomarkers; Female; Humans; Interleukin-1 Receptor-Like 1 Protein; Male; Middle Aged; Myocardial Infarction; Natriuretic Peptide, Brain; Percutaneous Coronary Intervention; Predictive Value of Tests; Prognosis; Prospective Studies; Risk Assessment; Risk Factors; ST Elevation Myocardial Infarction

To investigate the potential association between early tirofiban treatment and N-terminal pro-B-type natriuretic peptide (NT-proBNP) level after primary percutaneous coronary intervention (PCI).. Whether the use of adjunctive early glycoprotein IIb/IIIa inhibitors (GPIs) therapy, may affect the level of NT-proBNP after primary PCI is poorly studied.. Nine hundred and eighty four ST-elevation myocardial infarction (STEMI) patients undergoing primary PCI were randomized to either pre-hospital tirofiban administration or placebo. NT-proBNP levels were evaluated on admission before angiography (baseline) and 18-96 hr after PCI.. There were 918 (93.3%) patients with NT-proBNP values available at baseline and 865 (87.9%) post-PCI. Post-PCI NT-proBNP level dichotomized with median value as cut-off (968.8 pg/mL, IQR 430.9-1970.0) was significantly lower in patients treated with early tirofiban as compared to placebo (45.5% vs. 54.2% P = 0.011). At multivariate logistic regression analysis, independent predictors of post-PCI NT-proBNP level above the median were: NT-proBNP baseline level (OR 5.19; 95% CI, 2.92-9.25, P < 0.001), Killip class>I (OR 4.07; 95% CI 1.24-13.36, P = 0.021), anterior infarct location (OR 2.61; 95% CI 1.84-3.70, P < 0.001), age (years) (OR 1.04; 95% CI 1.03-1.06, P < 0.001), male gender (OR 0.38; 95% CI 0.26-0.57, P < 0.001), prior PCI (OR 0.49; 95% CI 0.27-0.90, P = 0.021) and tirofiban administration (OR 0.71; 95% CI 0.51-0.99; P = 0.045).. In a large cohort of STEMI patients, pre-hospital tirofiban administration was independently associate with a lower risk of high NT-proBNP level after primary PCI, supporting the potential benefit of early antithrombotic treatment administration in STEMI patients. The trial is registered under No. ISRCTN06195297.

Topics: Aged; Biomarkers; Double-Blind Method; Drug Administration Schedule; Emergency Medical Services; Female; Fibrinolytic Agents; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Percutaneous Coronary Intervention; Platelet Aggregation Inhibitors; Prospective Studies; Risk Assessment; Risk Factors; ST Elevation Myocardial Infarction; Time Factors; Tirofiban; Treatment Outcome

We aimed to evaluate the clinical performance of early administration of recombinant human B-type natriuretic peptide (rhBNP) to ST-elevation myocardial infarction (STEMI) patients receiving percutaneous coronary intervention (PCI) treatment.. In total, 185 patients diagnosed with STEMI were enrolled and randomised into either the placebo-treated (n = 88) or rhBNP-treated (n = 97) group. Patients were given either saline or rhBNP ten minutes before PCI and monitored with various cardiac parameters, including accelerated idioventricular rhythm, frequent ventricular premature beat (FVPB), ventricular tachycardia, systolic blood pressure, thrombolysis in myocardial infarction (TIMI) 3 gradation, corrected TIMI frame count (cTFC) and myocardial blush grade (MBG) 3 classification.. Our results revealed no difference in accelerated idioventricular rhythm between the two groups. However, FVPB and ventricular tachycardia were significantly decreased in rhBNP-treated patients compared to placebo-treated patients (p < 0.05). Moreover, the occurrence ratio of reperfusion-associated low blood pressure in rhBNP-treated patients was lower than in placebo-treated patients (p = 0.03), while no difference was observed in infarction-related arteries TIMI 3 blood flow between the two groups (p = 0.23). Importantly, measurement of post-reperfusion blood flow velocity via cTFC suggested that rhBNP treatment could significantly increase blood circulation (p = 0.003). After stent implantation, the acquisition rate of MBG 3 was higher in rhBNP-treated patients compared to placebo-treated patients (p = 0.071), although the difference was not significant.. We concluded that early administration of rhBNP can ameliorate the severity of reperfusion injury for STEMI patients receiving PCI treatment.

Topics: Aged; Arrhythmias, Cardiac; Coronary Circulation; Electrocardiography; Female; Humans; Hypotension; Male; Middle Aged; Natriuretic Peptide, Brain; Percutaneous Coronary Intervention; Recombinant Proteins; Reperfusion Injury; ST Elevation Myocardial Infarction; Stents; Tachycardia, Ventricular; Treatment Outcome

Aldosterone stimulates cardiac collagen synthesis. Circulating biomarkers of collagen turnover provide a useful tool for the assessment of cardiac remodeling in patients with an acute myocardial infarction (MI).. The REMINDER trial assessed the effect of eplerenone in patients with an acute ST-elevation Myocardial Infarction (STEMI) without known heart failure (HF), when initiated within 24 h of symptom onset. The primary outcome was almost totally (>90%) driven by natriuretic peptide (NP) thresholds after 1-month post-MI (it also included a composite of cardiovascular death or re-hospitalization or new onset HF or sustained ventricular tachycardia or fibrillation or LVEF ≤40% after 1-month post-MI). This secondary analysis aims to assess the extracellular matrix marker (ECMM) levels with regards to: (1) patients` characteristics; (2) determinants; (3) and eplerenone effect.. Serum levels of ECMM were measured in 526 (52%) of the 1012 patients enrolled in the REMINDER trial. Patients with procollagen type III N-terminal propeptide (PIIINP) above the median were older and had worse renal function (p < 0.05). Worse renal function was associated with increased levels of PIIINP (standardized β ≈ 0.20, p < 0.05). Eplerenone reduced PIIINP when the levels of this biomarker were above the median of 3.9 ng/mL (0.13 ± 1.48 vs. -0.37 ± 1.56 ng/mL, p = 0.008). Higher levels of PIIINP were independently associated with higher proportion of NP above the prespecified thresholds (HR = 1.95, 95% CI 1.16-3.29, p = 0.012).. Eplerenone effectively reduces PIIINP levels when baseline values were above the median. Eplerenone may limit ECMM formation in post-MI without HF.

Topics: Aged; Biomarkers; Double-Blind Method; Eplerenone; Female; Humans; Linear Models; Logistic Models; Male; Middle Aged; Mineralocorticoid Receptor Antagonists; Natriuretic Peptide, Brain; Peptide Fragments; Principal Component Analysis; Procollagen; Proportional Hazards Models; Spironolactone; ST Elevation Myocardial Infarction; Time Factors; Treatment Outcome; Troponin I; Troponin T

Remote ischaemic conditioning (rIC) is a cardioprotective tool which has shown promise in preclinical and clinical trials in the context of acute ischaemia. Repeated rIC post myocardial infarction may provide additional benefits which have not previously been tested clinically.. The trial assessed the role of daily rIC in enhancing left ventricular ejection fraction (LVEF) recovery in patients with impaired LVEF (<45%) after ST segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (P-PCI). Patients were recruited from four UK hospitals and randomised to receive either 4 weeks of daily rIC or sham conditioning using the autoRIC Device (CellAegis) starting on day 3 post P-PCI. The primary endpoint was the improvement in LVEF over 4 months assessed by cardiac MRI (CMR). Seventy-three patients (38 cases, 35 controls) completed the study.. The treatment and control groups were well matched at baseline including for mean LVEF (42.8% vs 44.3% respectively, p=0.952). There was no difference in the improvement in LVEF over 4 months between the treatment and control groups (4.8%±7.8% vs 4.6%±5.9% respectively, p=0.924). No differences were seen in the secondary outcome measures including changes in infarct size and left ventricular end-diastolic and systolic volumes, major adverse cardiac and cerebral event, mean Kansas City Cardiomyopathy Questionnaire score and change in N-terminal pro-brain natriuretic peptide levels.. Daily rIC starting on day 3 and continued for 4 weeks following successful P-PCI for STEMI did not improve LVEF as assessed by CMR after 4 months when compared with a matched control group.. NCT0166461.

Topics: Aged; Female; Hemodynamic Monitoring; Humans; Ischemic Preconditioning, Myocardial; Male; Middle Aged; Natriuretic Peptide, Brain; Outcome Assessment, Health Care; Peptide Fragments; Percutaneous Coronary Intervention; Postoperative Complications; ST Elevation Myocardial Infarction; Stroke Volume; Ventricular Dysfunction, Left

The aim of this study was to investigate whether low-level tragus stimulation (LL-TS) treatment could reduce myocardial ischemia-reperfusion injury in patients with ST-segment elevation myocardial infarction (STEMI).. The authors' previous studies suggested that LL-TS could reduce the size of myocardial injury induced by ischemia.. Patients who presented with STEMI within 12 h of symptom onset, treated with primary percutaneous coronary intervention, were randomized to the LL-TS group (n = 47) or the control group (with sham stimulation [n = 48]). LL-TS, 50% lower than the electric current that slowed the sinus rate, was delivered to the right tragus once the patients arrived in the catheterization room and lasted for 2 h after balloon dilatation (reperfusion). All patients were followed for 7 days. The occurrence of reperfusion-related arrhythmia, blood levels of creatine kinase-MB, myoglobin, N-terminal pro-B-type natriuretic peptide and inflammatory markers, and echocardiographic characteristics were evaluated.. The incidence of reperfusion-related ventricular arrhythmia during the first 24 h was significantly attenuated by LL-TS. In addition, the area under the curve for creatine kinase-MB and myoglobin over 72 h was smaller in the LL-TS group than the control group. Furthermore, blood levels of inflammatory markers were decreased by LL-TS. Cardiac function, as demonstrated by the level of N-terminal pro-B-type natriuretic peptide, the left ventricular ejection fraction, and the wall motion index, was markedly improved by LL-TS.. LL-TS reduces myocardial ischemia-reperfusion injury in patients with STEMI. This proof-of-concept study raises the possibility that this noninvasive strategy may be used to treat patients with STEMI undergoing primary percutaneous coronary intervention.

Topics: Aged; Angioplasty, Balloon, Coronary; Arrhythmias, Cardiac; Biomarkers; China; Creatine Kinase, MB Form; Echocardiography; Electrocardiography; Female; Humans; Inflammation Mediators; Male; Middle Aged; Myocardial Reperfusion Injury; Myoglobin; Natriuretic Peptide, Brain; Peptide Fragments; Proof of Concept Study; Prospective Studies; Recovery of Function; ST Elevation Myocardial Infarction; Stroke Volume; Time Factors; Transcutaneous Electric Nerve Stimulation; Treatment Outcome; Vagus Nerve Stimulation; Ventricular Function, Left

This study aims to investigate the effect of recombinant human brain natriuretic peptide (rhBNP) on renal function and contrast-induced nephropathy (CIN) incidence in ST-segment elevation myocardial infarction and heart failure (STEMI-HF) patients with mild renal insufficiency undergoing primary percutaneous coronary intervention (PCI). A total of 116 participants were randomized into rhBNP (rhBNP, n = 57) and nitroglycerin group (NIT, n = 59), receiving intravenous rhBNP or nitroglycerin from admission to 72 h after PCI. Renal function was assessed by serum creatinine (SCr), estimated glomerular filtration rate (eGFR), Cystatin-C (Cys-C) and β2-microglobulin before and after primary PCI, and calculated the incidence of CIN within 72 h after PCI. There were no significant differences in SCr, eGFR and β2-microglobulin between the two groups (P > 0.05, respectively). Compared with the NIT group, the total urinary volume within 72 h was higher while the level of Cys-C at 24 and 72 h after PCI was lower in the rhBNP group. rhBNP was associated with a decline in the incidence of CIN (12.28 vs. 28.81 %, P < 0.05). No differences were detected in mortality and re-hospitalization in 3 months between the two groups. The incidence of renal injury was not different between rhBNP and nitroglycerin in STEMI-HF patients with mild renal insufficiency. However, infusion of rhBNP was associated with a decline in incidence of CIN.

Topics: Creatinine; Electrocardiography; Female; Follow-Up Studies; Glomerular Filtration Rate; Heart Failure; Humans; Infusions, Intravenous; Male; Middle Aged; Natriuretic Agents; Natriuretic Peptide, Brain; Percutaneous Coronary Intervention; Prognosis; Prospective Studies; Recombinant Proteins; Renal Insufficiency; ST Elevation Myocardial Infarction

An elevated heart rate (HR) is an independent risk factor for mortality and morbidity in patients with acute heart failure (HF). The purpose of this study was to evaluate the impact of ivabradine, a selective HR-lowering agent, in patients with cardiogenic shock (CS) complicating ST-elevation acute myocardial infarction (AMI).. Patients with post-AMI CS were randomized to standard treatment (SDT, 28 patients) or to standard treatment plus ivabradine (I + SDT, 30 patients). In the presence of orotracheal intubation (OTI), ivabradine was administered by nasogastric intubation. HR, BP, New York Heart Association (NYHA) class, NT-proBNP, left ventricular ejection fraction (LVEF) and diastolic function (LVDF) were monitored at specific times after the onset of AMI. The primary (surrogate) end-point was the in-hospital halving of plasma NT-proBNP levels. The secondary end-points were cardiovascular death, hospital re-admission for worsening HF, and clinical and haemodynamic improvement.. Treatment groups were statistically similar with regard to age, gender distribution, cardiovascular risk factors, number of diseased vessels and overall treated lesions, AMI site and occurrence of OTI. In-hospital mortality was double in the SDT group in comparison with the I + SDT group (14.3 vs. 6.7 %), but the difference was not statistically significant. HR, BP, NT-proBNP and LVEF favorably changed in both groups, but the change was more relevant in the I + SDT group. LVDF significantly changed only in the I + SDT group (p < 0.01). Patients in the I + SDT group did not experience adverse effects.. Ivabradine in CS complicating AMI is safe, is associated with a short-term favourable outcome and can be effectively administered by nasogastric intubation.

Topics: Acute Disease; Adult; Aged; Benzazepines; Cardiovascular Agents; Female; Heart Failure; Humans; Ivabradine; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Prospective Studies; Risk Factors; Shock, Cardiogenic; ST Elevation Myocardial Infarction; Ventricular Function, Left

Decreased plasma vitamin D (VD) levels are linked to cardiovascular damage. However, clinical trials have not demonstrated a benefit of VD supplements on left ventricular (LV) remodelling. Anterior ST-elevation acute myocardial infarction (STEMI) is the best human model to study the effect of treatments on LV remodelling. We present a proof-of-concept study that aims to investigate whether VD improves LV remodelling in patients with anterior STEMI.. The VITamin D in Acute Myocardial Infarction (VITDAMI) trial is a multicentre, randomised, double-blind, placebo-controlled trial. 144 patients with anterior STEMI will be assigned to receive calcifediol 0.266 mg capsules (Hidroferol SGC)/15 days or placebo on a 2:1 basis during 12 months.. to evaluate the effect of calcifediol on LV remodelling defined as an increase in LV end-diastolic volume ≥10% (MRI).. change in LV end-diastolic and end-systolic volumes, ejection fraction, LV mass, diastolic function, sphericity index and size of fibrotic area; endothelial function; plasma levels of aminoterminal fragment of B-type natriuretic peptide, galectin-3 and monocyte chemoattractant protein-1; levels of calcidiol (VD metabolite) and other components of mineral metabolism (fibroblast growth factor-23 (FGF-23), the soluble form of its receptor klotho, parathormone and phosphate). Differences in the effect of VD will be investigated according to the plasma levels of FGF-23 and klotho. Treatment safety and tolerability will be assessed. This is the first study to evaluate the effect of VD on cardiac remodelling in patients with STEMI.. This trial has been approved by the corresponding Institutional Review Board (IRB) and National Competent Authority (Agencia Española de Medicamentos y Productos Sanitarios (AEMPS)). It will be conducted in accordance with good clinical practice (International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use - Good Clinical Practice (ICH-GCP)) requirements, ethical principles of the Declaration of Helsinki and national laws. The results will be submitted to indexed medical journals and national and international meetings.. NCT02548364; Pre-results.

Topics: Adult; Aged; Aged, 80 and over; Angioplasty, Balloon, Coronary; Biomarkers; Calcifediol; Chemokine CCL2; Double-Blind Method; Female; Fibroblast Growth Factor-23; Heart; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Natriuretic Peptide, Brain; Research Design; Spain; ST Elevation Myocardial Infarction; Ventricular Remodeling

The aim of the study was to investigate whether increased left ventricular mechanical dispersion is an early predictor for adverse cardiac remodeling in ST-segment elevation myocardial infarction patients who had post-percutaneous coronary intervention thrombolysis in myocardial infarction (TIMI) flow grade > 2.. A total of 119 post-percutaneous coronary intervention ST elevation myocardial infarction patients with TIMI flow grade >2 were prospectively included in the study. Left ventricular global longitudinal strain was quantified by 2-dimensional speckletracking echocardiography, and left ventricular mechanical dispersion was determined at baseline and after 1 year to assess adverse cardiac remodeling. The levels of circulating biomarkers were measured at the baseline. TIMI score and the Global Registry of Acute Coronary Events score systems were used to evaluate the prognosis of patients.. Patients with high quartile versus low quartile of left ventricular mechanical dispersion exerted higher Global Registry of Acute Coronary Events and TIMI score grades, left ventricular endsystolic volume, global longitudinal strain, and levels of the N-terminal fragment of brain natriuretic peptide and lower left ventricular ejection fraction. Multivariate log regression showed that N-terminal fragment of brain natriuretic peptide > 953 pg/mL, global longitudinal strain > -8%, and high quartile of left ventricular mechanical dispersion remained independent predictors for adverse cardiac remodeling. Addition of left ventricular mechanical dispersion to the N-terminal fragment of brain natriuretic peptide improved the discriminative potency of the whole model.. Measurement of left ventricular mechanical dispersion might be useful in determining the risk of adverse cardiac remodeling in post-percutaneous coronary intervention ST elevation myocardial infarction patients.

Topics: Humans; Myocardial Infarction; Natriuretic Peptide, Brain; Percutaneous Coronary Intervention; ST Elevation Myocardial Infarction; Stroke Volume; Treatment Outcome; Ventricular Function, Left; Ventricular Remodeling

Our aim was to assess systemic immune-inflammation index (SII) and NT-proBNP value either in singly or in combination to predict acute ST-elevation myocardial infarction (STEMI) patient prognosis.. Analyzed retrospectively the clinical features and laboratory data of STEMI confirmed patients in our hospital from January to December 2020. The levels of SII and NT-proBNP were detected. The Kaplan-Meier approach and Spearman's rank correlation coefficient were used to construct the overall major adverse cardiac event (MACE) curve. Multivariate Cox regression analysis was applied to detect MACE predictors. In addition, the Delong test and receiver operating characteristic (ROC) curve analyzed each factor performance on its own and composite multivariate index to predict MACEs.. The MACE group showed statistically significant differences in SII, NT- proBNP in comparison to the non-MACE group (. SII and NT-proBNP were independent indicators of clinical prognosis in acute STEMI patients, and they correlated positively. These factors could be combined to improve clinical prognosis.

Topics: Biomarkers; Humans; Inflammation; Myocardial Infarction; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Retrospective Studies; ST Elevation Myocardial Infarction

This experiment was carried out to observe the application value of recombinant human brain natriuretic peptide (rhBNP) in patients with ST-segment elevation myocardial infarction (STEMI) by primary percutaneous coronary intervention (PPCI), to provide reference for the future treatment of STEMI. In this study, we selected STEMI patients who underwent PPCI treatment in our hospital from October 2019 to December 2021 were selected as the study subjects, of which 46 received intravenous injections of rhBNP (research group), and 36 STEMI patients underwent PPCI (control group). There was no difference in clinical efficacy between the two groups (P>0.05). After treatment, high-sensitivity cardiac troponin I (hs-cTnI), creatine kinase-MB (CK-MB) and plasma N-terminal pro-BNP (NT-proBNP) levels decreased in both groups, with the research group lower than the control group; cardiac output (CO), cardiac index (CI) and mean arterial pressure (MAP) of the research group were lower than the control group's (P<0.05). The left ventricular ejection fraction (LVEF) in the research group was higher than that in the control group at 1 week and 1 month after treatment, while left ventricular end-diastolic diameter (LVEDD) and left ventricular end-systolic diameter (LVESD) were lower than those in the control group (P<0.05). There was also no difference in the rate of prognostic risk events between the two groups at 6 months of follow-up (P>0.05). Combining the results of these experiments above, we believe that the intravenous injection of rhBNP in STEMI patients undergoing PPCI treatment can improve cardiac function and promote the recovery of hemodynamics.

Topics: Humans; Injections, Intravenous; Natriuretic Peptide, Brain; Percutaneous Coronary Intervention; ST Elevation Myocardial Infarction; Stroke Volume; Ventricular Function, Left

Myocardial infarctions (MI) have been reported in adults with COVID-19. Although MIs are rare in children with COVID-19, cardiac involvement is still possible. In this case report, we present an adolescent with recent COVID-19 infection who presented with an ECG initially suggestive of myocardial infarction (MI). We describe how to differentiate between myocardial infarctions and myopericarditis. A 15-year-old boy, with a history of COVID-19 infection a month prior, presented to the emergency department with fever, abdominal pain, diarrhea, and chest pain. On ECG, he was found to have focal ST-segment elevations in V3 through V6. Given the immediate concern for MI, an emergent echocardiogram was done and showed normal left ventricular systolic function with no regional dyskinesia and normal coronary artery diameters. A repeat ECG showed diffuse ST elevations in the inferior leads and T-wave inversions on V5 and V6, confirming the diagnosis of myopericarditis. In conclusion, multisystem-inflammatory syndrome in children associated with COVID-19 (MIS-C) is a new entity describing a post-infectious inflammatory response in children with prior COVID-19 exposure. Cardiac involvement can include myopericarditis. Initial ECGs may show ST-changes suggestive of MI. However, serial ECGs and echocardiograms can differentiate between MI and myocarditis/myopericarditis. Even with COVID-19, MIs are extremely rare in children, and it is important to be aware of MIS-C and its cardiac complications.

Topics: Adolescent; Biomarkers; COVID-19; Diagnosis, Differential; Echocardiography; Electrocardiography; Emergency Service, Hospital; Humans; Male; Natriuretic Peptide, Brain; Peptide Fragments; Pericarditis; SARS-CoV-2; ST Elevation Myocardial Infarction; Systemic Inflammatory Response Syndrome; Troponin I

The role of left atrial (LA) function in the long-term prognosis of ST-elevation acute myocardial infarction (STEMI) is still unclear.Methods and Results: Percutaneous coronary intervention (PCI) was performed in 433 patients with the first episode of STEMI within 12 h of onset. The patients underwent echocardiography 24 h after admission. LA reservoir strain and other echocardiographic parameters were analyzed. Follow up was performed for up to 10 years (mean duration, 91 months). The primary endpoint was major adverse cardiovascular events (MACE): cardiac death or hospitalization due to heart failure (HF). MACE occurred in 90 patients (20%) during the follow-up period. Multivariate Cox hazard analyses showed LA reservoir strain, global longitudinal strain (GLS), age and maximum B-type natriuretic peptide (BNP) were the significant predictors of MACE. Kaplan-Meier curves demonstrated that LA reservoir strain <25.8% was a strong predictor (Log rank, χ. LA reservoir strain immediately after STEMI onset was a significant predictor of poor prognosis in patients, especially when combined with GLS.

Topics: Humans; Natriuretic Peptide, Brain; Percutaneous Coronary Intervention; Predictive Value of Tests; Prognosis; ST Elevation Myocardial Infarction; Ventricular Function, Left

Introduction：The predictive value of soluble suppression of tumorigenicity 2 (sST2) for the occurrence of major adverse cardiovascular events (MACEs) in patients with ST‑segment elevation myocardial infarction (STEMI) remains unclear.. We aimed to investigate the role of sST2 in predicting MACEs in STEMI patients after primary percutaneous coronary intervention (pPCI).. A total of 350 patients were enrolled in this study. The levels of sST2, N‑terminal pro-B‑type natriuretic peptide (NT‑proBNP), cardiac troponin I (TnI), and creatine kinase-MB (CK‑MB) were measured on admission as well as 24 hours and 5 days after pPCI. The end point was the incidence of MACEs.. Compared with the values on admission, sST2 levels increased 24 hours post pPCI and decreased significantly at day 5 after the procedure in the whole cohort. The pattern of sST2 level changes between the 3 time points was similar in the MACE and MACE‑free groups. Notably, the change in the sST2 level from admission to 24 hours post pPCI (Δ1sST2) was significantly higher in the MACE group. After multivariable adjustment, Δ1sST2 was an independent risk factor for MACEs, with an area under the curve of 0.621 (95% CI, 0.547-0.695). Patients with a greater Δ1sST2 had a significantly higher incidence of composite MACEs, coronary revascularization, and cardiac rehospitalization. However, the change in sST2 levels from admission to 5 days post pPCI, as well as the dynamic changes in NT‑proBNP, TnI, and CK‑MB levels had no predictive value.. The increase in plasma sST2 levels from admission to 24 hours post pPCI has a potential value for independently predicting the incidence of coronary revascularization and cardiac rehospitalization at 1 year in patients with STEMI.

Topics: Creatine Kinase; Humans; Natriuretic Peptide, Brain; Percutaneous Coronary Intervention; ST Elevation Myocardial Infarction; Troponin I

The value of serum carbohydrate antigen 125 (CA125) combined with N-terminal pro-B-type natriuretic peptide (NT-proBNP) in the evaluation of acute heart failure (AHF) after ST-segment elevation myocardial infarction (STEMI) remains unclear. The aim of this study was to evaluate the efficacy of CA125 combined with NT-proBNP in predicting AHF following STEMI. A total of 233 patients with STEMI were evaluated, including 39 patients with Killip II-IV and 194 patients with Killip I. The optimal cutoff point for predicting AHF was determined by receiver operating characteristic (ROC) curve, and the independent predictors of AHF were evaluated by multiple logistic regression. According to the cutoff value, it was divided into three groups: C1 = CA125 < 13.20 and NT-proBNP < 2300 (n = 138); C2 = CA125 ≥ 13.20 or NT-proBNP ≥ 2300 (n = 59); C3 = CA125 ≥ 13.20 and NT-proBNP ≥ 2300 (n = 36). Differences between groups were compared by odds ratio (OR). The levels of CA125 and NT-proBNP in AHF group were higher than those in non-AHF group (19.90 vs 10.00, P < .001; 2980.00 vs 1029.50, P < .001, respectively). The optimal cutoff values of CA125 and NT-proBNP for predicting AHF were 13.20 and 2300, both of which were independent predictors of AHF. The incidence of AHF during hospitalization was highest in C3 (69.44%), middle in C2 (20.34%) and lowest in C1 (1.45%). After adjustment for clinical confounding variables, compared with C1: C2 (OR = 6.41, 95% CI: 1.22-33.84, P = .029), C3 (OR = 19.27, 95% CI: 3.12-118.92, P = .001). Elevated CA125 and NT-proBNP are independent predictors of AHF in STEMI patients, and their combination can improve the recognition efficiency.

Topics: CA-125 Antigen; Heart Failure; Humans; Natriuretic Peptide, Brain; ST Elevation Myocardial Infarction

Previous studies suggested that N-terminal pro-brain natriuretic peptide (NT-proBNP) level is a powerful independent predictor of death or heart failure (HF) when measured at admission in patients with chest pain or acute coronary syndrome. Little is known about the role of NT-proBNP level measured during a hospitalization for ST segment elevation myocardial infarction (STEMI) in predicting clinical outcomes. We evaluated the optimal NT-proBNP timing (admission, 72 hours, or delta [Δ] NT-proBNP [72 hours minus admission]) to predict 1-year new-onset HF in STEMI patients.. We measured NT-proBNP levels at admission and 72 hours in 72 patients with STEMI. HF events were adjudicated and defined as hospitalization for HF or need for new initiation of a loop diuretic at 1-year follow-up. Values are presented as medians and interquartile range or frequencies (%) as appropriate. Cox regression analysis was used to determine predictors of adverse events. A receiver-operative-curve was constructed to identify the discriminative value and optimal cut-off points for NT-proBNP.. Patients (age 56 [49-64] years, males 59 [82%]) were followed for a median duration of 365 [180-365] days. HF events were recorded in 9 (12.5%) patients. NT-proBNP values at admission, 72 hours, and ΔNT-proBNP were 89 (26-268) pg/mL, 452 (223-1064) pg/mL, and 283 (68-686) pg/mL, respectively. NT-proBNP at 72 hours and ΔNT-proBNP, but not admission NT-proBNP predicted new-onset HF events at follow-up (P=0.03, P=0.002 and P=0.89, respectively). The optimal area under the curve of 0.771 (95%, CI [0.630-0.912], P= 0.009) and cut-off value of 830 pg/mL (sensitivity 79%; specificity 76%) were found for NT-proBNP at 72 hours. The Kaplan-Meier survival curves for NT-proBNP at 72 hours dichotomized above and below this cut-off value, confirmed NT-proBNP at 72 hours >830 pg/mL as predictive of HF events (log-rank statistic = 8.688, P=0.003).. NT-proBNP level at 72 hours and ΔNT-proBNP (72 hours minus admission), but not at time of admission, predicted HF events in patients following STEMI.

Topics: Biomarkers; Heart Failure; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; ST Elevation Myocardial Infarction

To determine the predictive value of pro-C-type natriuretic peptide (pro-CNP) measurement in plasma sampled on admission from patients presenting with ST-elevation myocardial infarction (STEMI).. Prospective cohort study.. Two University Hospitals in Denmark.. 1760 consecutive patients (470 females and 1290 males) with confirmed STEMI.. The main outcome was all-cause mortality at 1 year after presentation and the primary measure was pro-CNP concentration in plasma at admission in all patients and longitudinal measurements in a consecutive subgroup of 287 patients. A reference population (n=688) defined cut-off values of increased pro-CNP concentrations.. In female but not male patients presenting with STEMI, high concentrations of pro-CNP (≥median) at admission independently indicate a higher risk of all-cause mortality. The findings are remarkably specific for female patients, suggesting a different vascular phenotype beyond traditional measures of coronary artery flow compared with male patients.

Topics: Biomarkers; Female; Humans; Male; Natriuretic Peptide, Brain; Natriuretic Peptide, C-Type; Prognosis; Prospective Studies; ST Elevation Myocardial Infarction

This study aimed to investigate the impact of metabolic syndrome (MetS) with microalbuminuria on the improvement of cardiac function after acute myocardial infarction (AMI).. Nondiabetic patients with acute ST segment elevation MI (STEMI) who underwent coronary revascularization from 2013 to 2017 were included. They were grouped according to history of MetS and microalbuminuria test results as follows: microalbuminuria/MetS group, normoalbuminuria/MetS group, microalbuminuria/no MetS group, and normoalbuminuria/no MetS group. Left ventricular ejection fraction (LVEF) and serum N-terminal pro-brain natriuretic peptide (NT-proBNP) levels at the 6‑month follow-up were measured and the predictive value of MetS with microalbuminuria on recovery of cardiac function was assessed by multivariable logistic regression modeling.. A total of 530 STEMI patients were included (average age = 66.6 years). Analysis of covariance showed that LVEF recovery in the normoalbuminuria/no MetS group was better than that of the normoalbuminuria/MetS, microalbuminuria/no MetS, and microalbuminuria/MetS groups (49.22% vs. 48.92% vs. 47.48% vs. 46.99%, respectively, p < 0.001) when acute phase LVEF was the covariable. The NT-proBNP level of the normoalbuminuria/no MetS group at the 6‑month follow-up was lower than that of the microalbuminuria/MetS group (p < 0.001). Further regression analysis revealed that there was a lower probability of complete cardiac function recovery after 6 months in patients with microalbuminuria (odds ratio: 0.455) than in patients without microalbuminuria (95% CI: 0.316-0.655, p < 0.001).. Although post-AMI cardiac function in MetS patients with microalbuminuria can be improved after revascularization, the improvement is not as good as that of patients without microalbuminuria, suggesting that clinical attention should be paid to this subgroup.. HINTERGRUND: Ziel der vorliegenden Studie war es, den Einfluss eines metabolischen Syndroms (MetS) mit Mikroalbuminurie auf die Erholung der Herzfunktion nach akutem Myokardinfarkt (AMI) zu untersuchen.. Patienten ohne Diabetes mellitus mit akutem ST-Strecken-Hebungs-Infarkt (STEMI), bei denen zwischen 2013 und 2017 eine Revaskularisierung der Koronarien erfolgte, wurden in die Studie einbezogen. Sie wurden entsprechend ihrer Anamnese in Bezug auf MetS und den Testergebnissen auf Mikroalbuminurie folgendermaßen in Gruppen eingeteilt: Mikroalbuminurie/MetS-Gruppe, Normalbuminurie/MetS-Gruppe, Mikroalbuminurie/kein-MetS-Gruppe und Normalbuminurie/kein-MetS-Gruppe. Beim 6‑Monats-Follow-up wurden die linksventrikuläre Ejektionsfraktion (LVEF) und die Serumwerte für NT-proBNP („N-terminal pro-brain natriuretic peptide“) ermittelt sowie der prädiktive Wert von MetS mit Mikroalbuminurie für die Erholung der Herzfunktion mittels multivariabler logistischer Regressionsmodellierung bestimmt.. In die Studie wurden 530-STEMI-Patienten eingeschlossen (Durchschnittsalter: 66,6 Jahre). Die Analyse der Kovarianz zeigte, dass die Erholung der LVEF in der Normalbuminurie/kein-MetS-Gruppe besser war als in den Gruppen mit Normalbuminurie/MetS, Mikroalbuminurie/kein MetS und Mikroalbuminurie/MetS (49,22 vs. 48,92 vs. 47,48 vs. 46,99 %; p < 0,001), wenn die LVEF in der akuten Phase die Kovariable war. Der NT-proBNP-Wert der Normalbuminurie/kein-MetS-Gruppe beim 6‑Monats-Follow-up war niedriger als der in der Gruppe mit Mikroalbuminurie/MetS (p < 0,001). Die weitere Regressionsanalyse ergab, dass eine geringere Wahrscheinlichkeit für eine vollständige Erholung der Herzfunktion nach 6 Monaten bei Patienten mit Mikroalbuminurie bestand (Odds Ratio: 0,455) als bei Patienten ohne Mikroalbuminurie (95 %-Konfidenzintervall, 95 %-KI: 0,316–0,655; p < 0,001).. Auch wenn sich die Herzfunktion nach AMI bei Patienten mit MetS und Mikroalbuminurie nach Revaskularisierung wieder verbessern kann, ist diese Verbesserung nicht so gut wie die bei Patienten ohne Mikroalbuminurie, was ein Hinweis darauf ist, dass dieser Untergruppe besondere klinische Aufmerksamkeit gewidmet werden sollte.

Topics: Aged; Biomarkers; Humans; Metabolic Syndrome; Myocardial Infarction; Natriuretic Peptide, Brain; Peptide Fragments; ST Elevation Myocardial Infarction; Stroke Volume; Ventricular Function, Left

Long-term morbidity and mortality of patients with ST-segment-elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (PCI) remain substantial. Circulating microRNAs (miRNAs) play an important role in cardiovascular disease development. We aimed to identify circulating miRNAs associated with adverse cardiovascular events after acute myocardial infarction (AMI).. We performed a prospective, nested, case-control study of 932 patients with STEMI who underwent primary PCI. A 3-phase approach was conducted to screen candidate circulating miRNAs in 70 patients who subsequently experienced cardiac death, hospitalization for heart failure, or recurrent AMI (major adverse cardiovascular events [MACE] group) and in 140 patients matched for age, sex, time from symptom onset to blood collection and dual-antiplatelet therapy who did not report adverse cardiovascular events during 2-year follow-up (non-MACE group).. We found that miR-26a-5p, miR-21-5p, and miR-191-5p levels were lower in the MACE group than in the non-MACE group (all P < 0.001). Multivariate conditional logistic regression analysis revealed that miR-26a-5p, miR-21-5p, and miR-191-5p levels were significantly inversely associated with incident primary composite outcomes (all adjusted P < 0.01). Importantly, the combination of these 3 miRNAs plus B-type natriuretic peptide clearly improved the risk scores recommended in the current guidelines, as determined with the use of C-statistics, net reclassification, and integrated discrimination.. Our study provides proof-of-concept in humans that circulating miRNAs are associated with increased rates of distinct cardiovascular events, suggesting that they can serve as effective prognostic biomarkers and therapeutic targets for patients with AMI.

Topics: Biomarkers; Case-Control Studies; China; Circulating MicroRNA; Creatinine; Death, Sudden, Cardiac; Down-Regulation; Female; Heart Failure; Hospitalization; Humans; Male; Middle Aged; Multivariate Analysis; Natriuretic Peptide, Brain; Percutaneous Coronary Intervention; Prognosis; Prospective Studies; Recurrence; Risk Assessment; ST Elevation Myocardial Infarction; Troponin I; Up-Regulation

The presence of pathologic Q waves on admission electrocardiogram (ECG) in patients with anterior ST-elevated myocardial infarction (STEMI) has been related to adverse cardiac outcomes. Our study evaluates the prognostic value of QRS complex and Q waves in patients with STEMI undergoing percutaneous coronary intervention.. We prospectively analyzed the specific characteristics of QRS complex and pathologic Q waves on admission and on discharge ECG in 144 patients hospitalized for anterior STEMI. We correlated these findings with the development of left ventricular systolic dysfunction (LVSD), appearance of heart failure (HF) or death during follow-up, and levels of several biomarkers obtained 6 months after the index event.. Multivariate logistic regression analysis showed that QRS width (odds ratios [OR] 1.05, p = .001) on admission ECG and the sum of Q-wave depth (OR 1.06, p = .002) on discharge ECG were independent predictors of LVSD development. Moreover, QRS width on admission ECG was related to an increased risk of HF or death (OR 1.03, p = .026). Regarding biomarkers, QRS width on admission ECG revealed a statistically significant relationship with the levels of NT-pro-BNP at 6 months (0.29, p = .004); the sum of Q-wave depth (0.27, p = .012) and width (0.25, p = .021) on admission ECG was related to the higher levels of hs-cTnI; the sum of the voltages in precordial leads both on admission ECG (-0.26, p = .011) and discharge ECG (0.24, p = .046) was related to the lower levels of parathormone.. Assessment of QRS complex width and pathologic Q waves on admission and discharge ECGs aids in predicting long-term prognosis in patients with STEMI.

Topics: Biomarkers; Electrocardiography; Female; Heart; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Prospective Studies; ST Elevation Myocardial Infarction; Troponin I; Ventricular Dysfunction, Left

There is insufficient information on the relationship between the N-terminal pro-brain natriuretic peptide (NT-proBNP) level and collateral circulation (CC) formation after primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction. We analyzed 857 patients who underwent primary PCI. The serum NT-proBNP levels were measured on the day of admission, and the CC was scored according to Rentrop's classification. Log-transformed NT-proBNP levels were significantly higher in patients with good CC compared to those with poor CC (6.13 ± 2.01 pg/mL versus 5.48 ± 1.97 pg/mL, p < 0.001). The optimum cutoff value of log NT-proBNP for predicting CC was 6.04 pg/mL. Log NT-proBNP ≥ 6.04 pg/mL (odds ratio 2.23; 95% confidence interval 1.51-3.30; p < 0.001) was an independent predictor of good CC. CC development was higher in patients with a pre-TIMI flow of 0 or 1 than those with a pre-TIMI flow of 2 or 3 (22.6% versus 8.8%, p = 0.001). The incidence of left ventricular (LV) dysfunction (< 50%) was greater in patients with a pre-TIMI flow of 0 or 1 (49.8% versus 35.5%, p < 0.001). The release of NT-proBNP was greater in patients with LV dysfunction (34.3% versus 15.6%, p < 0.001). The incidence of good CC was greater in patients with log NT-proBNP levels ≥ 6.04 pg/ml (16.8% versus 26.2%, p = 0.003). The association between NT-proBNP and collateral formation was not influenced by pre-TIMI flow and LV function. NT-proBNP appears to reflect the degree of collateral formation in the early phase of STEMI and might have a new role as a useful surrogate biomarker for collateral formation in patients undergoing primary PCI.

Topics: Biomarkers; Humans; Natriuretic Peptide, Brain; Peptide Fragments; Percutaneous Coronary Intervention; ST Elevation Myocardial Infarction; Ventricular Dysfunction, Left

The pathophysiology of acute kidney injury (AKI) in ST-elevation myocardial infarction (STEMI) patients remains poorly explored. The involvement of the nitric oxide (NO) pathway has been demonstrated in experimental ischemic AKI. The aim of this study was to assess the predictive value of circulating biomarkers of the NO pathway for AKI in STEMI patients.. Four hundred and twenty-seven STEMI patients treated with primary percutaneous coronary intervention were included. The primary end point was AKI. Biomarkers of the NO pathway (plasma superoxide dismutase [SOD], uric acid, nitrite/nitrate [NOx], neopterin) as well as cardiac biomarkers (B-type natriuretic peptide [BNP] and troponin) were sampled 12 h after admission. The predictive value of circulating biomarkers was evaluated in addition to the multivariate clinical model.. AKI developed in 8.9% of patients. The 3-month mortality was significantly higher in patients with AKI (34.2 vs. 4.1%; p < 0.001). SOD, uric acid, NOx, neopterin, BNP and troponin were significantly associated with the development of AKI (area under curve [AUC]-receiver operating curve [ROC] ranging between 0.70 and 0.81). In multivariate analysis cardiogenic shock, neopterin, NOx and troponin were independent predictors of AKI. AUC-ROC of the association of multibiomarkers and clinical model was 0.90 and outperformed the predictive value of the clinical model alone. OR of NOx ≥45 µmol/L was 8.0 (95% CI 3.1-20.6) for AKI.. Biomarkers of the NO pathway are associated with the development of AKI in STEMI patients. These results provide insights into the pathophysiology of AKI and may serve at developing preventing strategies for AKI targeting this pathway.

Topics: Acute Kidney Injury; Aged; Aged, 80 and over; Biomarkers; Cardio-Renal Syndrome; Female; Humans; Male; Middle Aged; Multivariate Analysis; Myocardial Infarction; Natriuretic Peptide, Brain; Nitric Oxide; Oxidative Stress; Percutaneous Coronary Intervention; Predictive Value of Tests; Shock, Cardiogenic; ST Elevation Myocardial Infarction; Troponin

Cardiogenic shock complicating ST-elevation myocardial infarction is characterised by progressive left ventricular dysfunction causing inflammation and neurohormonal activation. Often, cardiogenic shock develops after hospital admission. Whether inflammation and a neurohormonal activation precede development of clinical cardiogenic shock is unknown.. Pro-atrial natriuretic peptide, copeptin, mid-regional pro-adrenomedullin and stimulation-2 admission plasma concentration were associated with late cardiogenic shock development in patients admitted with suspected ST-elevation myocardial infarction. Pro-atrial natriuretic peptide, mid-regional pro-adrenomedullin and copeptin had independent predictive value for late cardiogenic shock development.

Topics: Aged; Atrial Natriuretic Factor; Biomarkers; Female; Follow-Up Studies; Humans; Male; Natriuretic Peptide, Brain; Prognosis; Retrospective Studies; ROC Curve; Shock, Cardiogenic; ST Elevation Myocardial Infarction

Topics: Acute Coronary Syndrome; Aged; Biomarkers; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Prospective Studies; Renal Insufficiency, Chronic; Risk Factors; Romania; ST Elevation Myocardial Infarction

Risk stratification with specific biomarkers is proposed for tailored P2Y12 inhibitor therapy in patients with STEMI.. This nationwide registry and quality improvement study is from November 1, 2014, to June 30, 2017. In total, 11,512 STEMI patients received aspirin and P2Y12 receptor inhibitor (clopidogrel or ticagrelor) and underwent PCIs in hospitals. Of the patients, 2992 were prescribed ticagrelor and 8520 clopidogrel. The primary effectiveness outcome was major adverse cardiovascular and cerebrovascular events (MACCE: cardiac death, myocardial infarction, stent thrombosis, in-hospital ischemic stroke). The primary safety outcome was in-hospital major bleeding.. MACCE incidence was lower in the ticagrelor group than in the clopidogrel group (0.8% versus 1.2%; P=0.046), but under different NT-proBNP levels, cumulative hazards of MACCE were without statistical significance. Bleeding rates were higher in the ticagrelor group than in the clopidogrel group (all bleeding: 9.9% versus 6.9%, P<0.001; major bleeding: 4.0% versus 2.7%, P<0.001). The higher cumulative hazard of bleeding could be identified in the Kaplan-Meier curves. In the multivariate analysis, ticagrelor increased bleeding events, compared with clopidogrel, at NT-proBNP >1800 ng/L patients (all bleeding: HR 1.46; 95%CI, 1.07-2.01; major bleeding: HR 1.68, 95%CI, 1.03-2.74), but a low effect was found in those with lower NT-proBNP level. Subgroup analyses show that ticagrelor increased major bleeding in patients with left ventricular ejection fraction (LVEF) <0.50 (HR 3.29; 95% CI 1.61-6.74) (interaction p=0.03).. We found that ticagrelor, compared with clopidogrel, increased bleeding complications in hospitalized patients with NT-proBNP>1800 ng/L, especially in patients with EF < 0.50.

Topics: Acute Coronary Syndrome; Clopidogrel; Humans; Natriuretic Peptide, Brain; Peptide Fragments; Percutaneous Coronary Intervention; Platelet Aggregation Inhibitors; ST Elevation Myocardial Infarction; Stroke Volume; Ticagrelor; Treatment Outcome; Ventricular Function, Left

Background Despite restoration of epicardial flow following primary percutaneous coronary intervention (PPCI), microvascular reperfusion as reflected by ST-elevation resolution (ST-ER) resolution remains variable and its pathophysiology remains unclear. Methods and Results Using principal component analyses, we explored associations between 91 serum biomarkers drawn before PPCI clustered into 14 pathobiologic processes (including NT-proBNP [N-terminal pro-B-type natriuretic peptide] as an independent cluster), and (1) ST-ER resolution ≥50% versus <50%; and (2) 90-day composite of death, shock, and heart failure. Network analyses were performed to understand interbiomarker relationships between the ST-ER groups. Among the 1160 patients studied, 861 (74%) had ST-ER ≥50% at a median 40 (interquartile range, 23-70) minutes following PPCI, yet both groups had comparable post-PPCI TIMI (Thrombolysis in Myocardial Infarction) grade 3 flow (86.6% versus 82.9%;

Topics: Aged; Biomarkers; Coronary Circulation; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Percutaneous Coronary Intervention; Platelet Activation; Principal Component Analysis; Randomized Controlled Trials as Topic; Recovery of Function; Risk Assessment; Risk Factors; ST Elevation Myocardial Infarction; Time Factors; Treatment Outcome

Carbohydrate antigen 125 (CA125) is a congestion and inflammation biomarker and has been proved to be related to a worse prognosis in heart diseases. However, the precise relationship between elevated CA125 in patients with ST-segment elevation myocardial infarction (STEMI) has not yet been sufficiently studied. We set out to determine the association of CA125 with all-cause mortality at 6 months in STEMI. CA125, N-terminal pro brain natriuretic peptide (NTproBNP) and high sensitive C-reactive protein (hs-CRP) were measured in 245 patients admitted consecutively with STEMI undergoing coronary angioplasty. The mean age in our sample was 63.7 years, 64.9% were males, 28.3% had diabetes and 17.7% presented with acute heart failure (Killip ≥ 2). The median serum level of CA125 was 8.1 U/ml. At 6 months, the rate of all-cause mortality was 18% (44 patients). Receiver operating characteristic curve analysis demonstrated that CA125 presented similar performance to predict mortality as NTproBNP and hs-CRP. Patients with CA125 ≥ 11.48 had a higher rate of mortality (Hazard Ratio = 2.07, 95% confidence interval = 1.13-3.77, p = 0.017) than patients with CA125 < 11.48. This study suggests that elevated CA125 levels might be used to identify patients with STEMI with a higher risk of death at 6 months. CA125 seems to be a similar predictor of mortality compared to NTproBNP and hs-CRP.

Topics: Aged; Aged, 80 and over; Biomarkers; C-Reactive Protein; CA-125 Antigen; Coronary Angiography; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Prospective Studies; ROC Curve; ST Elevation Myocardial Infarction; Survival Analysis; Up-Regulation

To investigate the relationship between Transient Receptor Potential Vanilloid 6 (TRPV6) and ST-elevation acute myocardial infarction (STEMI) patients.. This observational research included a total of 221 patients with STEMI admitted during January 2017~August 2019. Additionally, 50 cases of non-ST-elevation acute myocardial infarction (NSTEMI) patients and 50 healthy individuals were enrolled as the control. Serum levels of TRPV6 were detected by ELISA method. The relationship between TRPV6, clinical characteristics, laboratory indices of CK-MB, TnI, NT-pro-B-type natriuretic peptide (NT-pro-BNP), C-reactive protein (CRP), and the left ventricular ejection fraction (LVEF%) was analyzed by statistical methods. K-M curve was performed for survival time.. Serum levels of TRPV6 were remarkably lower in STEMI and NSTEMI patients compared with the healthy control. Levels of NT-pro-BNP and CK-MB were significantly higher and serum levels of TRPV6 were dramatically lower in deceased STEMI patients in comparison with the surviving patients. The levels of TRPV6 were negatively correlated with CK-MB and NT-pro-BNP. Meanwhile, TRPV6 was negatively expressed in tissues of STEMI patients and positively expressed in normal tissues. Patients with lower TRPV6 levels had remarkably lower LVEF ratio, higher GRACE scores, higher CK-MB and NT-pro-BNP levels, as well as higher ratios of cardiovascular death, malignant arrhythmia, cumulative MACE, and shorter survival time than patients with higher TRPV6.. The lower expression of TRPV6 was associated with poor clinical outcomes and prognosis of STEMI patients.

Topics: Adult; Aged; Biomarkers; C-Reactive Protein; Calcium Channels; Female; Humans; Male; Middle Aged; Myocardial Infarction; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; ROC Curve; ST Elevation Myocardial Infarction; Stroke Volume; TRPV Cation Channels; Ventricular Function, Left

To investigate the association between plasma S100A1 level and ST-segment elevation myocardial infarction (STEMI) and potential significance of S100A1 in post-infarction cardiac function.. We examined the plasma S100A1 level in 207 STEMI patients (STEMI group) and 217 clinically healthy subjects for routine physical examination without a history of coronary artery disease (Control group). Baseline characteristics and concentrations of relevant biomarkers were compared. The relationship between S100A1 and other plasma biomarkers was detected using correlation analysis. The predictive role of S100A1 on occurrence of STEMI was then assessed using multivariate ordinal regression model analysis after adjusting for other covariates.. The plasma S100A1 level was found to be significantly higher (P<0.001) in STEMI group (3197.7±1576.0 pg/mL) than in Control (1423.5±1315.5 pg/mL) group. Furthermore, the correlation analysis demonstrated plasma S100A1 level was significantly associated correlated with hypersensitive cardiac troponin T (hs-cTnT) (r = 0.32; P < 0.001), creatine kinase MB (CK-MB) (r = 0.42, P < 0.001), left ventricular eject fraction (LVEF) (r = -0.12, P = 0.01), N-terminal prohormone of brain natriuretic peptide (NT-proBNP) (r = 0.61; P < 0.001) and hypersensitive C reactive protein (hs-CRP) (r = 0.38; P < 0.001). Moreover, the enrolled subjects who with a S100A1 concentration ≤ 1965.9 pg/mL presented significantly better cardiac function than the rest population. Multivariate Logistic regression analysis revealed that S100A1 was an independent predictor for STEMI patients (OR: 0.671, 95% CI 0.500-0.891, P<0.001). In addition, higher S100A1 concentration (> 1965.9 pg/mL) significantly increased the risk of STEMI as compared with the lower level (OR: 6.925; 95% CI: 4.15-11.375; P<0.001).. These results indicated that the elevated plasma S100A1 level is an important predictor of STEMI in combination with several biomarkers and also potentially reflects the cardiac function following the acute coronary ischemia.

Topics: Acute Coronary Syndrome; Aged; Biomarkers; C-Reactive Protein; Case-Control Studies; Creatine Kinase, MB Form; Echocardiography, Doppler; Female; Heart Function Tests; Humans; Logistic Models; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Retrospective Studies; S100 Proteins; ST Elevation Myocardial Infarction; Troponin T

Left ventricular aneurysm (LVA) is an important complication of acute myocardial infarction. In this study, we investigated the role of N- Terminal pro B type natriuretic peptide level to predict the LVA development after acute ST-segment elevation myocardial infarction (STEMI).. We prospectively enrolled 1519 consecutive patients with STEMI. Patients were divided into two groups according to LVA development within the six months after index myocardial infarction. Patients with or without LVAs were examined to determine if a significant relationship existed between the baseline N- Terminal pro B type natriuretic peptide values and clinical characteristics. A p-value < 0.05 was considered statistically significant.. LVA was detected in 157 patients (10.3%). The baseline N- Terminal pro- B type natriuretic peptide level was significantly higher in patients who developed LVA after acute MI (523.5 ± 231.1 pg/mL vs. 192.3 ± 176.6 pg/mL, respectively, p < 0.001). Independent predictors of LVA formation after acute myocardial infarction was age > 65 y, smoking, Killip class > 2, previous coronary artery bypass graft, post-myocardial infarction heart failure, left ventricular ejection fraction < 50%, failure of reperfusion, no-reflow phenomenon, peak troponin I and CK-MB and NT-pro BNP > 400 pg/mL at admission.. Our findings indicate that plasma N- Terminal pro B type natriuretic peptide level at admission among other variables provides valuable predictive information regarding the development of LVA after acute STEMI.

Topics: Adult; Aged; Biomarkers; Coronary Angiography; Female; Heart Aneurysm; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Prospective Studies; ROC Curve; Sensitivity and Specificity; Severity of Illness Index; ST Elevation Myocardial Infarction; Ventricular Dysfunction, Left; Young Adult

Topics: Humans; Myocardial Reperfusion Injury; Natriuretic Peptide, Brain; Percutaneous Coronary Intervention; ST Elevation Myocardial Infarction

The Global Registry of Acute Coronary Events (GRACE) score is recommended by current ST-elevation myocardial infarction (STEMI) guidelines. But it has inherent defects. The present study aimed to investigate the more compatible risk stratification for Chinese patients with STEMI and to determine whether the addition of biomarkers to the Korea Acute Myocardial Infarction Registry (KAMIR) score could enhance its predictive value for long-term outcomes.. A total of 1093 consecutive STEMI patients were included and followed up 48.2 months. Homocysteine, hypersensitive C-reactive protein (hs-CRP), and N-terminal pro-B-type natriuretic peptide (NT-proBNP) were detected. The KAMIR score and the GRACE score were calculated. The performance between the KAMIR and the GRACE was compared. The predictive power of the KAMIR alone and combined with biomarkers were assessed by the receiver-operating characteristic (ROC) curve.. The KAMIR demonstrated a better risk stratification and predictive ability than the GRACE (death: AUC = 0.802 vs. 0.721, P < 0.001; major adverse cardiovascular events (MACE): AUC = 0.683 vs. 0.656, P < 0.001). It showed that the biomarkers could independently predict death [homocysteine: HR = 1.019 (1.015-1.024), P < 0.001; hs-CRP: HR = 1.052 (1.000-1.104), P = 0.018; NT-pro BNP: HR = 1.142 (1.004-1.280), P = 0.021] and MACE [homocysteine: HR = 1.019 (1.015-1.024), P < 0.001; hs-CRP: HR = 1.012 (1.003-1.021), P = 0.020; NT-pro BNP: HR = 1.136 (1.104-1.168), P = 0.006]. When they were used in combination with the KAMIR, the area under the ROC curve (AUC) significantly increased for death [homocysteine: AUC = 0.802 vs. 0.890, Z = 5.982, P < 0.001; hs-CRP: AUC = 0.802 vs. 0.873, Z = 3.721, P < 0.001; NT-pro BNP: AUC = 0.802 vs. 0.871, Z = 2.187, P = 0.047; homocysteine, hs-CRP and NT-pro BNP: AUC = 0.802 vs. 0.940, Z = 6.177, P < 0.001] and MACE [homocysteine: AUC = 0.683 vs. 0.771, Z = 6.818, P < 0.001; hs-CRP: AUC = 0.683 vs. 0.712, Z = 2.022, P = 0.031; NT-pro BNP: AUC = 0.683 vs. 0.720, Z = 2.974, P = 0.003; homocysteine, hs-CRP and NT-pro BNP: AUC = 0.683 vs. 0.789, Z = 6.900, P < 0.001].. The KAMIR is better than the GRACE in risk stratification and prognosis prediction in Chinese STEMI patients. A combination of above-mentioned biomarkers can develop a more predominant prediction for long-term outcomes.

Topics: Biomarkers; C-Reactive Protein; Humans; Myocardial Infarction; Natriuretic Peptide, Brain; Peptide Fragments; Registries; Risk Factors; ROC Curve; ST Elevation Myocardial Infarction

High-sensitivity cardiac troponin T (hs-cTnT) represents the biomarker of choice for infarct size (IS) estimation in patients with acute ST-elevation myocardial infarction (STEMI). However, admission values of hs-cTnT are only weakly associated with IS. The aim of this study was to investigate the incremental value of different biomarkers measured on admission for IS estimation in STEMI patients.. In this prospective observational study, we included 161 consecutive STEMI patients treated with primary percutaneous coronary intervention (pPCI). The following biomarkers were assessed on admission: hs-cTnT, N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) and neutrophil/lymphocyte ratio (NLR). IS was determined by cardiac magnetic resonance (CMR) imaging 3 (Interquartile range [IQR] 2 to 4) days after the index event.. Patients with large IS (>19% of left ventricular myocardium) showed significantly higher levels of admission hs-cTnT (399.6 vs. 53.4 ng/L, p < .001), NT-pro-BNP (140 vs. 86 ng/L, p = .008) and NLR (6.4 vs. 4.1, p < .001). The combination of hs-cTnT, NT-pro-BNP and NLR on admission resulted in a significantly higher area under the curve (0.78; 95% CI 0.704 to 0.838, (p = .01)) for the prediction of large IS than admission hs-cTnT alone (0.69; 95% CI 0.619 to 0.767).. In STEMI patients undergoing pPCI, a comprehensive biomarker approach on admission including hs-cTnT, NT-pro-BNP and NLR was significantly better for immediate infarct severity estimation as compared to hs-cTnT alone.

Topics: Aged; Biomarkers; Female; Humans; Leukocyte Count; Logistic Models; Magnetic Resonance Imaging; Male; Middle Aged; Multivariate Analysis; Myocardium; Natriuretic Peptide, Brain; Peptide Fragments; Percutaneous Coronary Intervention; Predictive Value of Tests; Prognosis; Prospective Studies; ROC Curve; ST Elevation Myocardial Infarction; Troponin T; Ventricular Function, Left

B-line imaging by lung ultrasound (LUS) is a new tool for evaluating subclinical pulmonary congestion. The aim of this study was to explore the prognostic value of B-line number at admission in predicting symptomatic heart failure (HF) during hospitalization in acute anterior wall STEMI patients.. This was a prospective cohort study which consecutively enrolled 96 anterior wall STEMI patients without dyspnea at admission. Pulmonary auscultation, NT-proBNP test, LUS, and echocardiography were performed within 5 hours after primary PCI. Rale occurrence, plasma NT-proBNP levels, B-line number, LVEF, E/e' were recorded, and their predictive value for HF in-hospital was analyzed.. A total of 19 patients developed symptomatic HF. Median B-line number, NT-proBNP levels, and E/e' in the HF group were higher than those of the nonheart-failure (NHF) group (P < 0.001) while LVEF was lower (P = 0.002). There was no statistical difference in rale occurrence between the two groups. Multivariate logistic regression demonstrated that B-lines, E/e', and NT-proBNP independently predicted HF during hospitalization. According to the area under the ROC curve, the strongest predictor is B-lines (0.972), followed by NT-proBNP (0.936) and E/e' (0.928), and combining the three indicators was better than any single parameter (P = 0.048). B-line cutoff ≥18 could well predict HF event with specificity and sensitivity of 94.7% and 94.8%, respectively.. Subclinical pulmonary congestion reflected by B-lines can independently predict symptomatic HF during hospitalization in patients with anterior wall STEMI, LUS will act as a complementary tool for evaluating cardiac function.

Topics: Aged; Biomarkers; Echocardiography; Female; Heart Failure; Hospitalization; Humans; Lung; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Percutaneous Coronary Intervention; Predictive Value of Tests; Prognosis; Prospective Studies; Reproducibility of Results; Sensitivity and Specificity; ST Elevation Myocardial Infarction

New-onset atrial fibrillation (NOAF) is a complication not infrequent in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) and has been associated with worse in-hospital and long-term prognosis. We aimed to develop and validate a risk score based on common clinical risk factors and routine blood biomarkers to assess the early incidence of NOAF post-pPCI, before discharge.. The risk score for NOAF occurrence during hospitalisation (about 5 days) was developed in a cohort of 1135 consecutive STEMI patients undergoing pPCI while was externally validated in a temporal cohort of 771 STEMI patients. Biomarkers and clinical variables significantly contributing to predicting NOAF were assessed by multivariate Cox-regression analysis.. The ALBO risk score, comprising biomarkers and clinical variables that can be assessed in hospital setting, could help to identify high-risk patients for NOAF after pPCI so that a prompter action can be taken.

Topics: Age Factors; Aged; Aged, 80 and over; Atrial Fibrillation; Biomarkers; Cohort Studies; Female; Humans; Incidence; Kaplan-Meier Estimate; Leukocyte Count; Male; Middle Aged; Natriuretic Peptide, Brain; Obesity; Percutaneous Coronary Intervention; Proportional Hazards Models; Risk Assessment; Risk Factors; ST Elevation Myocardial Infarction

The aim of this study was to investigate whether low thiol levels are associated with peri-procedural factors during primary percutaneous coronary intervention (pPCI) upon admission with ST-segment elevation myocardial infarction (STEMI), and the prognostic value at 6-month follow-up.. A total of 241 consecutive acute STEMI patients who underwent pPCI and a control group of 67 individuals with a normal coronary angiography were enrolled in the study.. While age, contrast-induced nephropathy, N-terminal prohormone of brain natriuretic peptide (NT-proBNP), stent length, and creatinine were related to native thiol, NT-proBNP, contrast-induced nephropathy, and creatinine were related to total thiol. NT-proBNP was also related to the disulphide level. The left ventricular ejection fraction (LVEF) and the levels of native thiol, total thiol, low-density lipoprotein, and serum albumin were found to be independent predictors of major adverse cardiovascular events (MACEs) during 6 months of follow-up.. Initial lower native thiol, total thiol, LVEF, LDL, and serum albumin may be used to identify patients with an increased long-term risk of unfavorable cardiac events in case of STEMI.

Topics: Adult; Aged; Cohort Studies; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Percutaneous Coronary Intervention; Positron Emission Tomography Computed Tomography; ST Elevation Myocardial Infarction; Sulfhydryl Compounds; Young Adult

The long-term prognosis of ST-segment elevation myocardial infarction (STEMI) with acute heart failure (AHF) is poor. Identification of metabolic changes could provide understanding of the underlying pathological progress associated with adverse events in patients with STEMI and AHF. Therefore, the study aimed to identify new plasm metabolites associated with long-term adverse cardiovascular events in patients with STEMI and AHF.. Mass spectrometry measurements of 26 amino acids were performed in 138 patients with STEMI and AHF. Endpoints were adverse cardiac events (composite of death and heart failure hospitalization). Survival analysis was performed to determine independent predictors of amino acids.. During a 3-year follow-up, there were 32 deaths and 21 hospitalizations for heart failure (HF). Multivariable Cox regression analysis showed that branched-chain amino acid (BCAA) levels were independent predictors for adverse cardiovascular events in patients with STEMI and AHF (adjusted HR: 2.67, p < 0.001). The prognostic value of BCAA was better than that of N-terminal pro-B-type natriuretic peptide (area under the curve: 0.77 vs. 0.72) and Kaplan-Meier curves for adverse cardiac events (log-rank: 14.91 vs. 10.05). The combination of BCAAs and NT-proBNP yielded a stronger predictive value (area under the curve: 0.81, log-rank: 27.14). Importantly, addition of BCAAs and NT-pro BNP to the Global Registry of Acute Coronary Events score increased the C-statistic from 0.707 to 0.813, with a net reclassification improvement of 0.714.. Our study shows that increased plasma BCAA levels are associated with long-term adverse cardiovascular events in patients with STEMI and AHF. These findings suggest that dysregulated BCAA metabolism pathways affect clinical outcome after STEMI with AHF.

Topics: Acute Disease; Amino Acids, Branched-Chain; Biomarkers; Disease Progression; Female; Heart Failure; Humans; Male; Metabolome; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; ST Elevation Myocardial Infarction; Survival Rate

Topics: Angioplasty, Balloon, Coronary; Biomarkers; Female; Humans; Interleukin-1 Receptor-Like 1 Protein; Male; Middle Aged; Myocardial Reperfusion; Natriuretic Peptide, Brain; Peptide Fragments; Prospective Studies; ST Elevation Myocardial Infarction; Troponin T

The incidence of in-hospital cardiovascular adverse events (AEs) in patients with ST-segment elevation myocardial infarction (STEMI) following primary percutaneous coronary intervention (PCI) is relatively high. Identification of metabolic markers could improve our understanding of the underlying pathological changes in these patients. We aimed to identify associations between concentrations of plasma metabolites on admission and development of in-hospital AEs in post-PCI patients with STEMI. We used targeted mass spectrometry to measure plasma concentrations of 26 amino acid metabolites on admission in 96 patients with STEMI who subsequently developed post-PCI AEs and in 96 age- and sex-matched patients without post-PCI cardiovascular AEs. Principal component analysis (PCA) revealed that PCA-derived factors, including branched chain amino acids (BCAAs), were associated with increased risks of all three pre-specified outcomes: cardiovascular mortality/acute heart failure (AHF), cardiovascular mortality, and AHF. Addition of BCAA to the Global Registry of Acute Coronary Events risk score increased the concordance C statistic from 0.702 to 0.814 (p < 0.001), and had a net reclassification index of 0.729 (95% confidence interval, 0.466-0.992, p < 0.001). These findings demonstrate that high circulating BCAA concentrations on admission are associated with subsequent in-hospital AEs after revascularization in patients with STEMI.

Topics: Amino Acids, Branched-Chain; Biomarkers; Female; Hospitals; Humans; Male; Metabolomics; Middle Aged; Multivariate Analysis; Natriuretic Peptide, Brain; Peptide Fragments; Percutaneous Coronary Intervention; Principal Component Analysis; Risk Factors; ST Elevation Myocardial Infarction; Treatment Outcome

To investigate the changes and significance of circulating IL-39 in patients with acute coronary syndrome (ACS).. Serum IL-39 levels in ACS patients and normal coronary arteries were measured. The correlations of IL-39 with high-sensitivity CRP, cTnI, N-terminal of the prohormone brain natriuretic peptide (NTproBNP) and left ventricular ejection fraction were investigated.. The serum levels of IL-39 in ACS patients were significantly increased. IL-39 levels were positively correlated with NTproBNP, high-sensitivity CRP and cTnI, negatively correlated with left ventricular ejection fraction in ACS patients. The most significant correlation arose between serum IL-39 and NTproBNP in STEMI patients (r = 0.8309; p < 0.0001).. Circulating level of IL-39 might be a predictor of cardiac systolic dysfunction in ST-segment elevation myocardial infarction patients.

Topics: Acute Coronary Syndrome; Biomarkers; Female; Humans; Interleukins; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; ST Elevation Myocardial Infarction; Stroke Volume; Systole; Troponin I; Ventricular Dysfunction, Left

Adverse left ventricular (LV) remodeling after acute ST-elevation myocardial infarction (STEMI) is associated with morbidity and mortality. We studied clinical, biochemical and angiographic determinants of LV end diastolic volume index (LVEDVi), end systolic volume index (LVESVi) and mass index (LVMi) as global LV remodeling parameters 4 months after STEMI, as well as end diastolic wall thickness (EDWT) and end systolic wall thickness (ESWT) of the non-infarcted myocardium, as compensatory remote LV remodeling parameters. Data was collected in 271 patients participating in the GIPS-III trial, presenting with a first STEMI. Laboratory measures were collected at baseline, 2 weeks, and 6-8 weeks. Cardiovascular magnetic resonance imaging (CMR) was performed 4 months after STEMI. Linear regression analyses were performed to determine predictors. At baseline, patients were 21% female, median age was 58 years. At 4 months, mean LV ejection fraction (LVEF) was 54 ± 9%, mean infarct size was 9.0 ± 7.9% of LVM. Strongest univariate predictors (all p < 0.001) were peak Troponin T for LVEDVi (R

Topics: Aged; Biomarkers; Coronary Angiography; Creatine Kinase, MB Form; Female; Humans; Linear Models; Magnetic Resonance Imaging, Cine; Male; Middle Aged; Multivariate Analysis; Myocardium; Natriuretic Peptide, Brain; Peptide Fragments; Predictive Value of Tests; Risk Factors; ST Elevation Myocardial Infarction; Stroke Volume; Time Factors; Troponin T; Ventricular Function, Left; Ventricular Remodeling

Due to ischaemic time delays from the chest pain occurrence in acute ST elevation myocardial infarction (STEMI), prompt recruitment collaterals (PRCCs) to infarct-related artery (IRA) are the major protective structures during this period.. We aimed to investigate the clinical significance and determinants of PRCCs in acute STEMI patients.. A total of 1375 consecutive acute STEMI patients were prospectively enrolled in the study. The patients were divided into two groups, according to PRCCs to IRA; Rentrop ≤ 1 were defined as inadequate collateral development (ICD) group and Rentrop ≥ 2 defined as adequate collateral development (ACD) group.. Patients in the ICD group had higher incidence of baseline risk characteristics, including older age, hypertension, and diabetes mellitus; however, pre-infarct angina incidence was lower than in the ACD group (p < 0.05 for all). In addition, the ICD group had worse haemodynamic status on admission and 30-day mortality. Compared to the ACD group, the non-IRA chronic total occlusion (CTO), peak troponin-T, N-terminal pro-B-type natriuretic peptide (NT-proBNP), and high sensitivity C-reactive protein (hs-CRP) levels were higher in the ICD group. On multivariate logistic regression analysis, non-IRA CTO (b = 3.114, 95% CI 1.382-7.017, p < 0.006) with pre-infarction angina together with higher values of peak troponin-T, NT-proBNP, and hs-CRP were associated with PRCCs in acute STEMI.. Taking into account that the main message of the study is that if patients have higher cardiac biomarkers and adverse clinical findings (which, of note, may show the extent of myocardial infarction) and have non-IRA CTO, there is a higher chance that they will have inadequate collateralisation.

Topics: Aged; C-Reactive Protein; Coronary Circulation; Female; Hemodynamics; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Percutaneous Coronary Intervention; ST Elevation Myocardial Infarction; Treatment Outcome; Troponin T

Novel biomarkers representing different pathobiological pathways and their role in patients with acute myocardial infarction (AMI) were studied.. We retrospectively analysed serum levels of soluble suppression of tumorigenicity (sST2), growth-differentiation factor-15 (GDF-15), soluble urokinase plasminogen activator receptor (suPAR), heart-type fatty acid-binding protein (H-FABP) and plasma fetuin A in blood of patients with AMI (STEMI, n = 61; NSTEMI, n = 57) compared to controls with excluded coronary artery disease (n = 76). Furthermore, detailed correlation analysis was performed.. Compared with controls, in patients with STEMI and NSTEMI higher levels expressed as median of sST2 in pg/mL (STEMI: 13210·9, NSTEMI: 11989·1, control: 5248; P < 0·001), GDF-15 in pg/mL (STEMI: 818·8, NSTEMI 677·5, control 548·6; P < 0·001), suPAR in pg/mL (STEMI: 3461·1, NSTEMI: 3466·7, control: 2463·6; P < 0·001), H-FABP in ng/mL (STEMI: 5·8, NSTEMI: 5·4, control: 0·0; P < 0·001) and lower plasma fetuin A levels in μg/mL (STEMI: 95, NSTEMI: 54, control: 116·6; P < 0·001) were detected. Correlation analysis found clinical and biochemical parameters such as ejection fraction, length of hospital stay, creatine kinase, NT-proBNP and hs Troponin T levels as well as inflammatory markers (CRP, leucocytes) to be significantly correlated with novel biomarkers.. Plasma levels of novel biomarkers were significantly elevated (sST2, GDF-15, H-FABP, suPAR) or inversely downregulated (fetuin A) in patients with AMI compared to a control group with excluded coronary artery disease. Significant correlations with various clinical parameters and standard biochemical markers were found.

Topics: Aged; alpha-2-HS-Glycoprotein; Biomarkers; C-Reactive Protein; Case-Control Studies; Creatine Kinase; Fatty Acid Binding Protein 3; Female; Growth Differentiation Factor 15; Humans; Interleukin-1 Receptor-Like 1 Protein; Length of Stay; Leukocyte Count; Male; Middle Aged; Myocardial Infarction; Natriuretic Peptide, Brain; Non-ST Elevated Myocardial Infarction; Peptide Fragments; Receptors, Urokinase Plasminogen Activator; ST Elevation Myocardial Infarction; Stroke Volume; Troponin T

Although soluble suppression of tumorigenicity 2 (sST2) in serum is known to be associated with ischemic heart disease and heart failure, data regarding its prognostic impact in ST-segment elevation myocardial infarction (STEMI) is limited. We evaluated the prognostic impacts of serum sST2 and other serum biomarkers in STEMI patients undergoing primary percutaneous coronary intervention (PCI).. Consecutive all 323 patients with STEMI that underwent primary PCI were enrolled. Blood tests and samples were obtained in an emergency room. The primary endpoint was 1-year major adverse cardiovascular and cerebrovascular events (MACCEs), defined as a composite of cardiovascular death, non-fatal MI, non-fatal stroke, and ischemia-driven revascularization.. Mean age was 59.1±13.1 years (men 84%). MACCE (20 cardiovascular deaths, 7 non-fatal MI, 4 non-fatal stroke, 7 ischemia-driven revascularizations) occurred in 38 patients (12%). After adjusting for confounding factors, Cox regression analysis revealed that high serum sST2 (>75.8 ng/mL mean value, adjusted hazard ratio 2.098, 95% CI 1.008-4.367, p = 0.048) and high serum NT-proBNP level (>400 pg/mL, adjusted hazard ratio 2.606, 95% CI 1.086-6.257, p = 0.032) at the time of presentation independently predicted MACCE within a year of primary PCI. Furthermore, when high serum sST2 level was combined with high serum NT-proBNP level, the hazard ratio of MACCE was highest (adjusted hazard ratio 7.93, 95% CI 2.97-20.38, p<0.001).. Elevated serum levels of sST2 or NT-proBNP at the time of presentation were found to predict 1-year MACCE independently and elevated serum levels of sST2 plus NT-proBNP were associated with even poorer prognosis in patients with STEMI undergoing primary PCI.

Topics: Aged; Female; Humans; Interleukin-1 Receptor-Like 1 Protein; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Percutaneous Coronary Intervention; Prognosis; Risk Assessment; Risk Factors; ST Elevation Myocardial Infarction; Stroke

Familial hypercholesterolemia (FH), characterized by elevated plasma low-density lipoprotein-cholesterol (LDL-C) levels and premature coronary artery disease (CAD), remains mostly underdiagnosed and undertreated. We investigated the prevalence of clinical FH among Chinese patients with premature ST-segment-elevation myocardial infarction (STEMI) and one-year follow-up on their lipid management and cardiovascular events.. Four hundred and ninety-eight premature STEMI patients (363men) were enrolled. FH patients were identified using the Dutch Lipid Clinic Network Criteria. Lipid management and cardiovascular events in all patients were assessed.. Nineteen patients (3.8%) were diagnosed as definite/probable FH, 211 (42.4%) as possible FH and 268 (53.8%) as unlikely FH. All patients were divided into two main groups: unlikely FH (0-2 points) and possible FH (≥3 points). Possible FH patients were younger (50.1 years vs. 53.5 years) with higher NT-proBNP level (3014.15 pg/mL vs. 2326.25 pg/mL), occurrence of multi-vessel CAD (37.4% vs. 18.3%), lower LVEF (47% vs. 49%) and more severe Killip classification (Class 3, 20.0% vs. 9.7%). Follow-up data were available for 203 patients from the possible FH group and 243 patients from the unlikely FH group. High intensity statin intake status (%) of possible FH vs. unlikely FH was as follows: 1) on admission: 4.8% vs. 0.4%; 2) at discharge: 10.4% vs. 1.6% and 3) at one year follow-up: 5.4% vs. 0.8%. A significantly low percentage of possible FH patients (18.7% vs. 51.4%) achieved target LDL-C levels. There were no significant differences in MACE defined as a composite of cardiogenic shock or Class IV heart failure, recurrent MI, cardiovascular-related rehospitalization, TLR and CV death between the two groups. However, the proportion of cardiogenic shock or Class IV heart failure was significantly higher in possible FH patients group (5.9% vs.1.2%).. Clinical diagnosis of possible FH is common in Chinese patients with premature STEMI. A low proportion of FH patients were prescribed high intensity statins. Despite aggressive cholesterol-lowering drugs, a significantly lower proportion of FH patients achieved LDL-C targets compared to unlikely FH patients. Possible FH patients were younger with a significantly higher occurrence of multi-vessel CAD and impaired cardiac function.

Topics: Age Factors; Anticholesteremic Agents; Asian People; China; Cholesterol, LDL; Comorbidity; Coronary Artery Disease; Female; Follow-Up Studies; Humans; Hyperlipoproteinemia Type II; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Prevalence; Risk Factors; ST Elevation Myocardial Infarction

Interleukin (IL)-16, a polypeptide cytokine, plays a crucial role in the inflammatory process, acting as a chemoattractant for peripheral immune cells and has been linked to various inflammatory diseases. However, its role in patients with acute myocardial infarction (AMI) is unclear.We retrospectively analyzed serum levels of IL-16 in blood of patients with (STEMI, n = 45) and without ST-segment elevation myocardial infarction (NSTEMI, n = 42) compared with controls with excluded coronary artery disease (n = 55). Furthermore, correlation analysis with inflammatory cells, C-reactive protein (CRP) levels, dendritic cell precursors (DCPs), and other clinical and biochemical markers was performed.Compared with controls, patients with STEMI and NSTEMI evidenced higher levels of IL-16 in pg/mL (STEMI: 759.38 ± 471.54, NSTEMI: 677.77 ± 438.8, control: 500.45 ± 432.21; P = .002). IL-16 correlated with CRP (r = 0.26, P = .001), leucocytes (r = 0.38, P < .001), NT-proBNP (r = 0.20, P = .02) and hsTnT (r = 0.25, P = .004). Circulating myeloid DCPs, plasmacytoid DCPs, and total DCPs showed a significant inverse correlation to IL-16 levels (r = -0.21, P = .01; r = -0.23, P = .005; r = -0.26, P = .002, respectively).Interleukin-16 might play an important role in the inflammatory process of patients suffering from AMI and correlates with inflammatory cell activation and clinical and biochemical markers. The cytokine IL-16 might upregulate the proinflammatory response and recruitment of inflammatory cells into infarcted myocardium.

Topics: C-Reactive Protein; Female; Humans; Interleukin-16; Male; Middle Aged; Natriuretic Peptide, Brain; Non-ST Elevated Myocardial Infarction; Peptide Fragments; Retrospective Studies; ST Elevation Myocardial Infarction

Acute coronary syndrome remains a significant problem for cardiologists. Despite improved therapy, mortality remains extremely high once CHF becomes symptomatic. Multimarker approach in cardiovascular risk prediction was proved as the most effective tool. One of the promising biomarkers is a stress-induced marker growth differentiation factor 15 (GDF-15). Purpose of the study was to improve stratification methods of CHF progression risk as a complication of ACS by studying levels of GDF-15. In our study we showed association between high level of GDF-15, determined at the first 24 hours after ACS, and CHF progression after 12 months.

Topics: Acute Coronary Syndrome; Biomarkers; Chronic Disease; Disease Progression; Female; Follow-Up Studies; Growth Differentiation Factor 15; Heart Failure; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; ST Elevation Myocardial Infarction

To investigate the evolution of left ventricular global strain in anterior myocardial infarction patients treated with emergency percutaneous coronary intervention (PCI).
 Methods: A total of 54 patients with PCI were enrolled as a PCI group. Forty healthy subjects were enrolled as a control group. Dynamic cardiac images were collected. All of these images were analyzed off-line by velocity vector imaging (VVI) software. N-terminal pro-B-type natriuretic peptide (NT-proBNP) was measured with an electrochemiluminescence immunoassay through the Elecsys 1010/2010 system. Correlation analysis were undertaken between VVI and NT-proBNP levels in blood.
 Results: In PCI group, only globle longitudinal strain (GLS) was significantly increased 3 day after operation (P<0.05). GLS and globle circumferencial strain (GCS) were markedly increased 6 months after operation (P<0.05). In PCI group, left ventricular GLS 1 d to 6 months after PCI shows positive correlation with lgNT-proBNP levels (r=0.66, P<0.001). GLS value was -12.50% at the 3rd day after operation, indicating the improvment of cardiac function in the first and sixth month after PCI.
 Conclusion: The change of Left ventricular globle longitudinal systolic function after emergency PCI may be more sensitive to the improvement of myocardial stunning after STEMI reperfusion; GLS value (-12.50%) at the 3rd day after operation predict the improvment of cardiac function in the first and sixth months after PCI.. 目的：应用速度向量成像(velocity vector imaging，VVI)技术探讨前壁急性ST段抬高型心肌梗死(ST-elevation myocardial infarction，STEMI)患者首次急诊经皮冠状动脉介入治疗(percutaneous coronary intervention，PCI)术后左心室整体纵向应变(global longitudinal strain，GLS)与整体环向应变(global circumferencial strain，GCS)动态演变及其临床价值。方法：PCI组前壁STEMI患者54例行首次急诊PCI术，对照组40例行冠状动脉造影术。采集术前与术后各时间点二维动态超声心动图，启动VVI软件分析。同时抽取部分对象静脉血测定血浆N-末端脑钠肽原(N-terminal pro-B-type natriuretic peptide，NT-proBNP)浓度。研究PCI组整体应变术后演变，并分析PCI组左心室整体纵向应变与血浆NT-proBNP的相关性。结果：PCI术后3 d GLS显著升高(P<0.05)，术后6个月GLS与GCS均显著增高(P<0.05)。术后多时间点左室GLS与血浆NT-proBNP呈正相关(r=0.66，P<0.001)。急诊PCI术后3 d左室GLS收缩期峰值–12.50%可评价术后1及6个月血浆NT-proBNP改变。结论：左室整体纵向应变动态演变可为间接评价急性前壁STEMI急诊PCI术后心肌顿抑功能提供参考，术后3 d左室整体纵向应变–12.50%有望预测术后1，6个月心功能改善。.

Topics: Aged; Anterior Wall Myocardial Infarction; Biomarkers; Diagnosis, Computer-Assisted; Female; Heart; Heart Ventricles; Humans; Male; Middle Aged; Myocardial Reperfusion; Myocardial Stunning; Natriuretic Peptide, Brain; Peptide Fragments; Percutaneous Coronary Intervention; Prognosis; ST Elevation Myocardial Infarction; Systole; Ventricular Function, Left

Topics: Aged; Biomarkers; Cicatrix; Female; Follow-Up Studies; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Percutaneous Coronary Intervention; ST Elevation Myocardial Infarction; Troponin T; Ventricular Dysfunction, Left

Cardiac and renal functions are major independent predictors of outcomes in both ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI). As B-type natriuretic peptide (BNP) seems to be a major mediator in the cross-talk between heart and kidneys, we aimed at evaluating its capacity to reflect cardiac and renal function in patients with STEMI and NSTEMI.. We measured BNP plasma levels at hospital admission in 619 patients with STEMI (n = 346) and NSTEMI (n = 273), grouped according to left ventricular ejection fraction (LVEF; > or ≤40%) and estimated glomerular filtration rate (eGFR; > or ≤ 60 ml/min/1.73 m).. Median BNP values were 82 (38-186), 121 (40-342), 219 (80-685), and 474 (124-1263) pg/ml in patients with normal LVEF and eGFR (n = 347), with LVEF 40% or less and eGFR higher than 60 ml/min/1.73 m (n = 120), with LVEF higher than 40% and eGFR 60 ml/min/1.73 m or less (n = 86), and with combined LVEF and eGFR reductions (n = 66), respectively (P < 0.0001). At general linear model, both LVEF higher than 40% (P < 0.0001) and eGFR 60 ml/min/1.73 m or less (P < 0.0001) independently predicted BNP values. At multivariable analysis, BNP, LVEF 40% or less, and eGFR 60 ml/min/1.73 m or less were found to be independent predictors of the combined end point of in-hospital death, cardiogenic shock, need for renal replacement therapy, or mechanical ventilation (P = 0.003; P < 0.0001; P = 0.01, respectively).. BNP plasma levels are closely related to LVEF and eGFR at hospital admission, in both STEMI and NSTEMI patients. Future studies should investigate whether BNP levels can summarize in a single parameter the prognostic information provided separately by cardiac and renal dysfunction.

Topics: Aged; Aged, 80 and over; Biomarkers; Female; Glomerular Filtration Rate; Heart; Hospitalization; Humans; Italy; Logistic Models; Male; Middle Aged; Multivariate Analysis; Natriuretic Peptide, Brain; Non-ST Elevated Myocardial Infarction; Prognosis; Prospective Studies; ST Elevation Myocardial Infarction; Stroke Volume; Ventricular Function, Left

We have previously shown that older thrombus is associated with a twofold higher long-term mortality in ST-segment elevation myocardial infarction (STEMI) patients after primary percutaneous coronary intervention (pPCI). We evaluated whether the addition of the presence of older thrombus to a multimarker model would result in increased predictive power for 1-year mortality in STEMI patients.. The study population (n = 1442) consists of STEMI patients treated with thrombus aspiration during pPCI. Patients were included if aspirated thrombus material could histopathologically be classified according to thrombus age (n = 870) and laboratory measurements of biomarkers (cardiac troponin T, glucose, N-terminal pro-brain natriuretic peptide, estimated glomerular filtration rate and C-reactive protein) were available. The additional prognostic value of the presence of older thrombus beyond multiple biomarkers and established clinical risk factors was evaluated using multivariate Cox regression models.. Serum biomarker concentrations were similar between patients with fresh and older thrombus. Sixty patients (7%) died within 1 year. The presence of older thrombus remained strongly associated with mortality at 1 year after multivariable adjustment for multiple biomarkers and established clinical risk factors. Addition of older thrombus to either a model including clinical risk factors and biomarkers or a model including solely biomarkers resulted in significant increases in the discriminative value, evidenced by net reclassification improvement and integrated discriminative improvement.. The presence of older thrombus provides independent complementary information to a multimarker model including established clinical risk factors and multiple biomarkers for predicting 1-year mortality in STEMI patients treated with pPCI and thrombus aspiration.

Topics: Aged; C-Reactive Protein; Female; Follow-Up Studies; Humans; Male; Middle Aged; Mortality; Natriuretic Peptide, Brain; Peptide Fragments; Percutaneous Coronary Intervention; Prognosis; Risk Factors; ST Elevation Myocardial Infarction; Thrombectomy; Thrombosis; Time Factors; Troponin T

To assess the clinical utility of non-contrast cardiac CT (CCT) immediately after successful percutaneous coronary intervention (PCI) for predicting the risk of left ventricle (LV) remodeling in the management of patients with acute myocardial infarction (AMI), 35 patients with AMI underwent non-contrast CCT immediately after PCI. Volume and transmural extent of myocardial delayed enhancement (DE) were assessed on non-contrast CCT. Serial echocardiography and serologic biomarkers were evaluated at baseline and at 2 and 12 months after AMI. Based on an increase in left ventricular end-diastolic volume (LVEDV) ≥20 % at 2 months, patients were classified into two groups: LV remodeling (group 1, n = 14) and no LV remodeling (group 2, n = 21). Clinical characteristics, imaging parameters, and serologic biomarkers were compared between the two groups. Higher incidence of hypertension, longer time to reperfusion, and higher Killip classification at admission were observed for group 1 than for group 2, but these differences were not statistically significant (P > 0.05). Greater volume and transmural extent of DE on non-contrast CCT and poorer resolution of ST-segment elevation on ECG were observed in group 1 compared to group 2, but these results were not statistically significant (P > 0.05). Measurement of biochemical markers showed that probrain natriuretic peptide (proBNP), initial high sensitivity C reactive protein (hs-CRP), and maximum troponin T level were significantly higher in group 1 than in group 2 (P < 0.05) at 2 months. Based on the trend of greater volume and transmural extent of DE in group 1 compared to group 2, non-contrast CCT immediately after PCI, in combination with serologic biomarkers (proBNP, hs-CRP, and troponin T) might be useful for managing patients with AMI.

Topics: Aged; Biomarkers; C-Reactive Protein; Coronary Angiography; Echocardiography; Electrocardiography; Female; Humans; Hypertrophy, Left Ventricular; Male; Middle Aged; Multidetector Computed Tomography; Natriuretic Peptide, Brain; Peptide Fragments; Percutaneous Coronary Intervention; Predictive Value of Tests; Prospective Studies; Republic of Korea; Risk Assessment; Risk Factors; ST Elevation Myocardial Infarction; Time Factors; Treatment Outcome; Troponin T; Ventricular Function, Left; Ventricular Remodeling

The Zwolle score is recommended to identify low-risk patients eligible for early hospital discharge after ST-elevation myocardial infarction (STEMI), but since only one third of STEMI has low Zwolle score, hospital discharge is frequently delayed. B-type natriuretic peptide (BNP) also provides prognostic information after STEMI. The aim of the study was to test the hypothesis that patients with high Zwolle score associated with low BNP share similar outcomes than those with low Zwolle score.. The study population consisted of 1032 consecutive STEMI patients in whom BNP was measured 24h after chest pain onset. The area under the curve of Zwolle score and plasma BNP for 30-day mortality were 0.82 and 0.87, p=0.39. A BNP threshold of 200pg/ml had sensitivity of 100% and specificity of 34% for predicting 30-day mortality. Patients with high Zwolle score and BNP≤200pg/ml (n=183) had similar mortality and hospital stay to those with low Zwolle score (0% vs. 0.5% and 5 vs. 5days, both p=1.0). By contrast, patients with high Zwolle score and BNP>200pg/ml had the highest mortality (6.7%) and the longest hospital stay (6days), both p<0.01.. STEMI patients with high Zwolle score but low BNP share similar outcomes with those with low Zwolle score and should be eligible for early discharge. Hence, using the rule of "low-Zwolle or low-BNP" might increase the number of STEMI patients that might be eligible for early discharge.

Topics: Aged; Female; Humans; Length of Stay; Male; Middle Aged; Natriuretic Peptide, Brain; Prognosis; Prospective Studies; Risk Assessment; Sensitivity and Specificity; Severity of Illness Index; ST Elevation Myocardial Infarction

Several biomarkers have individually been shown to be useful for risk stratification in patients with acute myocardial infarction (MI). The optimal multimarker strategy remains undefined.. Biomarkers representing different pathobiological axes were studied, including myocardial stress/structural changes (NT-pro B-type natriuretic peptide [NT-proBNP], midregional proatrial natriuretic peptide [MR-proANP], suppression of tumorigenicity 2 [ST2], galectin-3, midregional proadrenomedullin [MR-proADM], and copeptin), myonecrosis (troponin T), and inflammation (myeloperoxidase [MPO], high sensitivity C-reactive protein [hsCRP], pregnancy-associated plasma protein A [PAPP-A], and growth-differentiation factor-15 [GDF-15]), in up to 1258 patients from Clopidogrel as Adjunctive Reperfusion Therapy-Thrombolysis in Myocardial Infarction 28 (CLARITY-TIMI 28), a randomized trial of clopidogrel in ST-elevation MI (STEMI). Patients were followed for 30 days. Biomarker analyses were adjusted for traditional clinical variables. Forward step-wise selection was used to assess a multimarker strategy. After adjustment for clinical variables and using a dichotomous cutpoint, 7 biomarkers were each significantly associated with a higher odds of cardiovascular death or heart failure (HF) through 30 days, including NT-proBNP (adjusted odds ratio [ORadj], 2.54; 95% CI, 1.47-4.37), MR-proANP (2.18; 1.27-3.76), ST2 (2.88; 1.72-4.81), troponin T (4.13; 1.85-9.20), MPO (2.75; 1.20-6.27), hsCRP (1.96, 1.17-3.30), and PAPP-A (3.04; 1.17-7.88). In a multimarker model, 3 biomarkers emerged as significant and complementary predictors of cardiovascular death or HF: ST2 (ORadj, 2.87; 1.61-5.12), troponin T (2.34; 1.09-5.01 and 4.13, 1.85-9.20, respectively for intermediate and high levels), and MPO (2.49; 1.04-5.96). When added to the TIMI STEMI Risk Score alone, the multimarker risk score significantly improved the C-statistic (area under the curve, 0.75 [95% CI, 0.69-0.81] to 0.82 [0.78-0.87]; P=0.001), net reclassification index (0.93; P<0.001), and integrated discrimination index (0.09; P<0.001).. In patients with STEMI, a multimarker strategy that combines biomarkers across pathobiological axes of myocardial stress, myocyte necrosis, and inflammation provides incremental prognostic information for prediction of cardiovascular death or HF.

Topics: Adrenomedullin; Aged; Atrial Natriuretic Factor; Biomarkers; Blood Proteins; C-Reactive Protein; Cardiovascular Diseases; Female; Galectin 3; Galectins; Glycopeptides; Growth Differentiation Factor 15; Heart Failure; Humans; Interleukin-1 Receptor-Like 1 Protein; Male; Middle Aged; Natriuretic Peptide, Brain; Odds Ratio; Peptide Fragments; Peroxidase; Pregnancy-Associated Plasma Protein-A; Prognosis; Protein Precursors; Risk Assessment; ST Elevation Myocardial Infarction; Troponin T

Coronary plaque rupture mediating acute ST segment elevation myocardial infarction (STEMI) is associated with a systemic inflammatory response. Whether early temporal changes in inflammatory biomarkers are associated with angiographic and electrocardiographic markers of reperfusion and subsequent clinical outcomes is unclear. In the APEX-AMI biomarker substudy, 376 patients with STEMI had inflammatory biomarkers measured at the time of hospital presentation and 24 h later. The primary outcome was the 90-day composite of death, shock, or heart failure. Secondary reperfusion outcomes were (1) worst least residual ST segment elevation (ST-E: <1 mm, 1 to <2 mm, ≥2 mm) and (2) post-percutaneous coronary intervention (PCI) TIMI flow grade (0/1/2 vs 3) and TIMI myocardial perfusion grade (TMPG 0/1 vs 2/3). The 90-day incidence of death, shock or heart failure was 21.3 % in this cohort. Electrocardiographic reperfusion (worst residual ST-E <1 mm, 1 to <2 mm, ≥2 mm) was associated with differences in 24 h change in N-terminal proB-type natriuretic peptide (NT-proBNP) (1192.8, 1332.5, 1859.0 ng/mL; p = 0.043) and the pro-inflammatory cytokines Interleukin (IL)-6 (14.0, 13.6, 22.1 pg/mL; p = 0.016), IL-12 (-0.5, -0.9, -0.1 pg/mL; p = 0.013), and tumor necrosis factor α (TNFα) (1.0, 0.6, 3.6 pg/mL; p = 0.023). Angiographic reperfusion (TMPG 0/1 vs 2/3) was associated with changes in median NT-proBNP (2649.3, 1382.7 ng/mL; p = 0.002) and IL-6 (28.7, 15.1; p = 0.040). After adjustment for baseline covariates, the 24 h change in the pro-inflammatory cytokine TNFα [hazard ratio (HR) 0.49; 95 % CI 0.26-0.95; p = 0.035] and the anti-inflammatory cytokine IL 10 (HR 1.41; 95 % CI 1.06-1.87; p = 0.018) were independently associated with the primary composite outcome. Successful coronary reperfusion was associated with less systemic inflammatory response and greater temporal inflammatory changes were independently associated with higher 90-day composite of death, shock, or heart failure. These findings provide support for an association between success of reperfusion, an acute STEMI inflammatory response and subsequent clinical outcomes.

Topics: Biomarkers; Cohort Studies; Coronary Angiography; Electrocardiography; Heart Failure; Humans; Inflammation; Interleukin-10; Interleukin-6; Myocardial Reperfusion; Natriuretic Peptide, Brain; Peptide Fragments; Shock, Cardiogenic; ST Elevation Myocardial Infarction; Time Factors; Treatment Outcome; Tumor Necrosis Factor-alpha

Takotsubo cardiomyopathy (TTC) is a clinical condition mimicking acute myocardial infarction. A specific biomarker for TTC screening is required, but until now, no single biomarker has been established for the early diagnosis of TTC and differentiation from ST-segment elevation myocardial infarction (STEMI). In our study we focused on the simple markers that are available in every hospital.. In 66 consecutive patients (pts) who were hospitalized with TTC and 66 pts with STEMI, cardiac biomarkers, such as NT-proBNP, TnI, CK and CKMB mass were determined during 12h from admission and compared with demographic, clinical and echocardiographic findings.. The concentration of NTproBNP was greater in pts with TTC than STEMI (4702pg/ml vs 2138pg/ml). The concentration of TnI and CKMB mass was greater in the STEMI group than in the TTC group (TnI: 2.1ng/ml and CK MB mass: 9.5ng/ml in pts with TTC vs TnI: 19ng/ml and CK MB mass: 73.3ng/ml in pts with STEMI). The NTproBNP/TnI ratio and NTproBNP/CKMB mass ratio were, respectively, 2235.2 and 678.2 in pts with TTC and 81.6 and 27.5 in pts with STEMI (p<0.001). Moreover, the NTproBNP/EF ratio was also statistically significant (110.4 in TTC group and 39.4 in STEMI group).. NTproBNP/TnI, NTproBNP/CKMB mass and NTproBNP/EF ratios can distinguish TTC from STEMI at an early stadium. The most accurate marker is the NTproBNP/TnI ratio.

Topics: Aged; Aged, 80 and over; Biomarkers; Diagnosis, Differential; Female; Humans; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Retrospective Studies; ST Elevation Myocardial Infarction; Takotsubo Cardiomyopathy

Left ventricular (LV) remodeling is an important pathophysiological event that develops following acute myocardial infarction and causes LV systolic dysfunction. Mechanisms such as apoptosis, necrosis, and oxidative stress play an important role in LV remodeling.. This study aimed to determine the relationship between the development of LV remodeling and the apoptosis marker M30 in patients with anterior ST-segment elevation myocardial infarction (STEMI) who were treated with primary percutaneous coronary intervention (PCI).. This retrospective study included 255 consecutive patients (210 men, 45 women, mean age 54.9±11.8 years) with anterior STEMI who were treated with primary PCI. Blood samples were obtained from each patient at admission and 24 h after admission for measurements of M30, M65, oxidative parameters, and biochemical parameters. Transthoracic echocardiography was performed in each patient within 24 h of infarction and 6 months after infarction. LV remodeling was defined as greater than or equal to 20% increase in end-diastolic volume 6 months after primary PCI. The patients were divided into two groups on the basis of 6 months of post-primary PCI follow-up findings: LV remodeling group and non-LV remodeling group.. In all, 60 patients received LV remodeling and 195 did not receive LV remodeling at 6 months after primary PCI. Total oxidative stress, M30 and M65 levels, and the oxidative stress index were significantly higher and the total antioxidant capacity and M65/M30 ratio were lower in the LV remodeling group (P<0.05, for all). Brain natriuretic peptide, M30, and oxidative stress index were independent predictors of LV remodeling (P<0.05 for all). Receiver operating characteristic curve analysis showed that the M30 cut-off value for predicting LV remodeling was 144.9 U/l (80% sensitivity and 77% specificity, P<0.001).. In patients with anterior STEMI treated with primary PCI, the apoptosis marker M30 might be useful for predicting LV remodeling and subsequent LV systolic dysfunction.

Topics: Adult; Aged; Anterior Wall Myocardial Infarction; Apoptosis; Area Under Curve; Biomarkers; Coronary Angiography; Echocardiography; Female; Humans; Keratin-18; Male; Middle Aged; Natriuretic Peptide, Brain; Oxidative Stress; Peptide Fragments; Percutaneous Coronary Intervention; Predictive Value of Tests; Retrospective Studies; ROC Curve; ST Elevation Myocardial Infarction; Time Factors; Treatment Outcome; Ventricular Function, Left; Ventricular Remodeling

Presence of microvascular obstruction (MVO) derived from cardiac magnetic resonance (CMR) imaging is among the strongest outcome predictors after ST-segment elevation myocardial infarction (STEMI). We aimed to investigate the comparative predictive values of different biomarkers for the occurrence of MVO in a large cohort of reperfused STEMI patients.. This study included 128 STEMI patients. CMR imaging was performed within the first week after infarction to assess infarct characteristics, including MVO. Admission and peak concentrations of high-sensitivity cardiac troponin T (hs-cTnT), creatine kinase (CK), N-terminal pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity C-reactive protein (hs-CRP), lactate dehydrogenase (LDH), aspartate transaminase (AST) and alanine transaminase (ALT) were measured.. MVO was detected in 69 patients (54%). hs-cTnT, CK, hs-CRP, LDH, AST and ALT peak concentrations showed similar prognostic value for the prediction of MVO (area under the curve (AUC) = 0.77, 0.77, 0.68, 0.79, 0.78 and 0.73, all p > 0.05), whereas the prognostic utility of NT-proBNP was weakly lower (AUC = 0.64, p < 0.05). Combination of these biomarkers did not increase predictive utility compared to hs-cTnT alone (p = 0.349).. hs-cTnT, CK, hs-CRP, LDH, AST and ALT peak concentrations provided similar prognostic value for the prediction of MVO. The prognostic utility of NT-proBNP was lower. Combining these biomarkers could not further improve predictive utility compared to hs-cTnT alone.

Topics: Biomarkers; C-Reactive Protein; Coronary Circulation; Coronary Occlusion; Coronary Vessels; Creatine Kinase; Follow-Up Studies; Humans; Magnetic Resonance Imaging, Cine; Microcirculation; Natriuretic Peptide, Brain; Peptide Fragments; Percutaneous Coronary Intervention; Prospective Studies; ST Elevation Myocardial Infarction; Time Factors; Troponin T

To analyze the clinical outcomes of emergency percutaneous intervention in acute myocardial infarction (AMI) during hospital, and to find the relevant risk factors for the prognosis and cardiac events. 
 Methods: We retrospective analyzed the patient with acute ST segment elevation myocardial infarction, who was successfully performed emergency percutaneous coronary intervention (PCI) in the Cardiac Cath Lab of the Second Xiangya Hospital from January 2010 to December 2014. According to situation for cardiovascular events, patients were divided into 2 groups. The clinical factors were compared between the 2 groups.
 Results: The incidence of adverse event was 22% (67/304). By using t test and χ2 analysis, we found that Cr, NT-proBNP, HCT, WBC, age>75, Killip grade≥2, TIMI flow after PCI≤2, arrhythmia, multi-vessel lesion, ST-segment resolution≥50%, long D2B time are statistically different between the 2 groups. Logistic analysis revealed that HCT, NT-proBNP, Killip grade≥2, TIMI flow after PCI≤2, ST-segment resolution≥50%, long D2B time were important predictors for cardiac events in-hospital.
 Conclusion: HCT, NT-proBNP, Killip grade≥2, TIMI flow after PCI≤2, ST-segment resolution≥50%, long D2B time are important predictors for cardiac events in-hospital. The prognosis for AMI patient after emergency PCI could be improved and the incidence of cardiac event in hospital could be reduced if the high risk factors can be properly handled.. 目的：分析急诊经皮冠状动脉介入(percutaneous coronary intervention，PCI)治疗急性心肌梗死(acute myocardial infarction，AMI)患者的病例资料，旨在探讨影响急诊PCI治疗AMI患者住院期间不良预后的相关因素。方法：回顾性分析2010年1月至2014年12月中南大学湘雅二医院行急诊PCI治疗AMI的患者资料，根据是否发生心血管不良事件分为事件组及非事件组，比较两组间可能引起心血管不良事件发生的相关因素。结果：不良事件的发生率为22%(67/304)；通过t检验或χ2检验发现：肌酐，脑钠肽(brain natriuretic peptide，BNP)，红细胞比容，白细胞、年龄>75岁，Killip分级≥2级，术后心肌梗死溶栓治疗(thrombolysis in myocardial infarction，TIMI)血流≤2级，术前发生心律失常、多支病变，术后2 h ST段回落率<50%，长就诊至球囊扩张(door-to-balloon，D2B)时间差异具有统计学意义(P<0.05)，进一步进行logistic回归分析，其结果显示：红细胞比容(red blood cell specific volume，HCT)、N 端脑钠肽激素原前体(N-terminal pro-brain natriuretic peptide，NT-proBNP)、Killip分级≥2级、术后TIMI血流≤2级、术后2 h ST段回落率<50%、长D2B时间是心血管不良事件发生的重要影响因素。结论：HCT，NT-proBNP，Killip分级≥2级，术后TIMI血流≤2级，术后2 h ST段回落
率<50%、长D2B时间是心血管不良事件发生的重要影响因素，对上述高危患者进行积极的监测与处理，能够有效改善AMI患者急诊PCI术后的预后，减少住院期间不良事件的发生。.

Topics: Aged; Arrhythmias, Cardiac; Emergency Treatment; Female; Humans; Inpatients; Male; Natriuretic Peptide, Brain; Peptide Fragments; Percutaneous Coronary Intervention; Prognosis; Retrospective Studies; Risk Factors; ST Elevation Myocardial Infarction; Treatment Outcome

It remained unclear whether the combination of the Canada Acute Coronary Syndrome Risk Score (CACS-RS) and N-terminal pro-brain natriuretic peptide (NT-pro-BNP) could have a better performance in predicting clinical outcomes in acute ST-elevation myocardial infarction (STEMI) patients with primary percutaneous coronary intervention.. A total of 589 consecutive STEMI patients were enrolled. The potential additional predictive value of NT-pro-BNP with the CACS-RS was estimated. Primary endpoint was in-hospital mortality and long-term poor outcomes.. The incidence of in-hospital death was 3.1%. Patients with higher NT-pro-BNP and CACS-RS had a greater incidence of in hospital death. After adjustment for the CACS-RS, elevated NT-pro-BNP (defined as the best cutoff point based on the Youden's index) was significantly associated with in hospital death (odd ratio = 4.55, 95%CI = 1.52-13.65, p = 0.007). Elevated NT-pro-BNP added to CACS-RS significantly improved the C-statistics for in-hospital death, as compared with the original score (0.762 vs. 0.683, p = 0.032). Furthermore, the addition of NT-pro-BNP to CACS-RS enhanced net reclassification improvement (0.901, p < 0.001) and integrated discrimination improvement (0.021, p = 0.033), suggesting effective discrimination and reclassification. In addition, the similar result was also demonstrated for in-hospital major adverse clinical events (C-statistics: 0.736 vs. 0.695, p = 0.017) or 3-year mortality (0.699 vs. 0.604, p = 0.004).. Both NT-pro-BNP and CACS-RS are risk predictors for in hospital poor outcomes in patients with STEMI. A combination of them could derive a more accurate prediction for clinical outcome s in these patients.

Topics: Acute Coronary Syndrome; Biomarkers; China; Electrocardiography; Follow-Up Studies; Incidence; Natriuretic Peptide, Brain; Peptide Fragments; Percutaneous Coronary Intervention; Predictive Value of Tests; Prognosis; Retrospective Studies; Risk Assessment; ROC Curve; ST Elevation Myocardial Infarction; Survival Rate; Time Factors