Key result
Emergency PCI significantly reduced 1-month MACE (34.5% vs 59.5% for elective PCI and 65.9% for drug treatment; P<0.05) and improved early exercise tolerance in STEMI patients.
Why the study?
Does emergency PCI improve plasma NT-proBNP levels and early exercise tolerance in patients with acute ST-segment elevation myocardial infarction compared to elective PCI or drug treatment?
Cohort (n=146)
Does emergency PCI improve plasma NT-proBNP levels and early exercise tolerance in patients with acute ST-segment elevation myocardial infarction compared to elective PCI or drug treatment?
Absolute Event Rate: 34.5% vs 59.5%
p-value: p=<0.05
Emergency PCI in STEMI patients significantly improves NT-proBNP levels, LVEF, exercise tolerance, and reduces short-term MACE compared to elective PCI or medical therapy alone.
May support emergency PCI preference in STEMI cohorts; leaves open causal confirmation in randomized trials.
OBJECTIVE: The aim of this study was to investigate the effect of different treatment interventions on plasma N-terminal fragment of the prohormone brain natriuretic peptide (NT-proBNP) levels and early exercise tolerance in patients with acute ST-segment elevation myocardial infarction. METHODS: 146 consecutive patients with ST-segment elevation myocardial infarction who received emergency percutaneous coronary intervention (PCI) (n = 55), elective PCI (n = 47), or drug treatment (n = 44) were included. Plasma NT-proBNP levels and left ventricular ejection fractions (LVEFs) were measured before the treatment intervention and at 1 week and 1 month afterward. An exercise stress test was performed 1 month after the intervention, and the occurrences of major adverse cardiac events (MACE) were recorded at the 1-month follow-up. RESULTS: Compared with the elective PCI and drug treatment groups, at 1 week and 1 month after the intervention, the emergency PCI group's plasma NT-proBNP levels were significantly lower, and the group's LVEFs were significantly higher (all P < 0.05). There was a significantly negative correlation between plasma NT-proBNP levels and LVEFs in each group (all P < 0.05). The positive exercise stress testing rates were 13.0%, 32.6%, and 38.6% in the emergency PCI, elective PCI, and drug treatment groups, respectively (P < 0.05). The occurrences of MACE in the emergency PCI, elective PCI, and drug treatment groups were 34.5%, 59.5%, and 65.9%, respectively (P < 0.05). CONCLUSION: Emergency PCI resulted in lower plasma NT-proBNP levels, lower MACE incidence, higher LVEFs, and better early exercise tolerance compared with elective PCI or drug treatment, indicating that lower plasma NT-proBNP levels predicted a better prognosis.
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Wu et al. (2012) conducted a cohort in Acute ST-segment elevation myocardial infarction (n=146). Emergency percutaneous coronary intervention (PCI) vs. Elective PCI or drug treatment was evaluated on Major adverse cardiac events (MACE) at 1-month follow-up (p=<0.05). Emergency PCI significantly reduced 1-month MACE (34.5% vs 59.5% for elective PCI and 65.9% for drug treatment; P<0.05) and improved early exercise tolerance in STEMI patients.
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