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November 1, 2016Open Access

Cutoff Value of Admission N-Terminal Pro-Brain Natriuretic Peptide Which Predicts Poor Myocardial Perfusion after Primary Percutaneous Coronary Intervention for ST-Segment-Elevation Myocardial Infarction.

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Why the study?

Does admission NTProBNP level predict poor myocardial perfusion in STEMI patients undergoing successful PPCI?

Population

90 consecutive patients admitted with acute STEMI who underwent primary percutaneous coronary intervention…

Design

Cohort

Follow-up

90 minutes post-PPCI

Authors

MAMohamed AbdeldayemAin Shams UniversityEEwedaAin Shams UniversityAEAshraf ElsherbinyAl-Azhar University

Discussion

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Implication

NTProBNP thresholds may identify STEMI patients at risk for poor post-PPCI perfusion; hypothesis-generating and requires prospective validation.

Key Points

  • This research aims to determine the optimal cutoff value of NTProBNP that predicts poor myocardial perfusion after PPCI in STEMI patients.
  • Enrolled 90 consecutive STEMI patients undergoing PPCI with post-procedural TIMI flow grade 3.
  • Measured NTProBNP levels from admission blood samples and assessed post-procedural myocardial blush grade and ST segment resolution.
  • Evaluated sensitivity and specificity of NTProBNP cutoff values for predicting STR and MBG outcomes.
  • NTProBNP ≥ 420 ng/L predicted STR < 50% with 98.4% sensitivity and 92.3% specificity (P<0.001).
  • NTProBNP ≥ 570 ng/L predicted MBG 0/1 with 92.2% sensitivity and 66.7% specificity (P<0.001).
  • Higher NTProBNP levels correlate with poor myocardial perfusion outcomes post-PPCI.

Structured PICO

Does admission NTProBNP level predict poor myocardial perfusion in STEMI patients undergoing successful PPCI?

P
Population
90 consecutive patients admitted with acute STEMI who underwent primary percutaneous coronary intervention (PPCI) and achieved post-procedural TIMI flow grade 3 in the infarct-related artery. Mean age 53.6 ± 10.9 years, 74.4% males.
I
Intervention
Admission N-terminal pro-brain natriuretic peptide (NTProBNP) measurement
O
Outcome
ST segment resolution (STR) < 50% at 90 minutes following PPCI, and co-primary angiographic endpoint of postprocedural myocardial blush grade (MBG) 0/1 at the end of PPCIsurrogate

Elevated admission NTProBNP levels can predict poor microvascular perfusion (incomplete ST-segment resolution and poor myocardial blush) in STEMI patients despite successful epicardial recanalization with PPCI.

Cite This Study

Abdeldayem et al. (2016) studied this question.

synapsesocial.com/papers/6a713935ac440176ef29e5behttps://doi.org/10.6515/acs20151112b
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Also Consider

Synapse has enriched 3 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Localization and mechanism of secretion of B-type natriuretic peptide in comparison with those of A-type natriuretic peptide in normal subjects and patients with heart failure.1994 · 1,346 citations
  2. 2Angiographic Assessment of Myocardial Reperfusion in Patients Treated With Primary Angioplasty for Acute Myocardial Infarction1998 · 1,308 citations
  3. 3Lack of myocardial perfusion immediately after successful thrombolysis. A predictor of poor recovery of left ventricular function in anterior myocardial infarction.1992 · 1,059 citations