Key result
Delayed primary PCI linked to ~30% higher risk of elevated NT-proBNP per hour in STEMI.
Why the study?
The impact of early primary coronary angioplasty performed within 3 hours on serum NT-proBNP levels in first ST-elevation acute MI patients was unclear.
Does early primary coronary angioplasty (≤ 3 hours) reduce serum NT-proBNP levels in patients with a first ST-elevation myocardial infarction?
Observational (n=111)
Does early primary coronary angioplasty (≤ 3 hours) reduce serum NT-proBNP levels in patients with a first ST-elevation myocardial infarction?
Effect estimate: 30% increased risk per hour delay
A one-hour delay in primary PCI for STEMI significantly increases the risk of elevated NT-proBNP on admission, which correlates with worse left ventricular systolic function.
May support expedited primary PCI in STEMI to limit NT-proBNP rise; leaves open whether this improves outcomes.
OBJECTIVE: Primary coronary angioplasty (PCI) performed in the first hours after the onset of chest pain plays an important role in the prevention of death and heart failure after acute myocardial infarction (MI). Levels of circulating natriuretic peptides (BNP and NT-proBNP) reflect the severity of left ventricular (LV) dysfunction. The blood concentration of these peptides is increased in patients with MI. The aim of this study is to evaluate whether early PCI (< or = 3 hours) after onset of chest pain modulates NT-proBNP levels in patients with first ST-elevation acute MI. METHODS AND RESULTS: Serum NT-proBNP levels were measured on hospital admission and 4 to 5 days post MI. Transthoracic echocardiography was performed on the 4th day after MI. We included 111 consecutive patients with first ST-elevation acute MI treated with PCI with stent implantation. In 55 patients (49.5%) PCI was performed within 3 hours after the onset of symptoms (the study group). Multivariate analysis revealed that only the time from the onset of chest pain to PCI and EF/WMI were independently associated with serum NT-proBNP > 105 pg/ml on admission. Only EF/WMI and evolution of non-Q myocardial infarction correlated with an NT-proBNP level > 388.5 pg/ml on discharge. CONCLUSIONS: NT-proBNP concentration measured both on admission and 4 to 5 days after acute MI independently correlates with echocardiographic parameters of LV systolic function (EF and WMSI). One hour delay in PCI raises the risk of NT-proBNP level elevation on admission by 30%.
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Szadkowska et al. (2007) conducted an observational in first ST-elevation acute MI (n=111). Early PCI (≤ 3 hours after onset of chest pain) vs. PCI > 3 hours was evaluated on Serum NT-proBNP > 105 pg/ml on admission (30% increased risk per hour delay). A one-hour delay in primary PCI increases the risk of NT-proBNP level elevation on admission by 30% in patients with a first ST-elevation myocardial infarction.