Comparison of Usefulness of N-Terminal Pro-Brain Natriuretic Peptide as an Independent Predictor of Cardiac Function Among Admission Cardiac Serum Biomarkers in Patients With Anterior Wall Versus Nonanterior Wall ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Haeck, Joost D.E.; Verouden, Niels J.W.; Kuijt, Wichert J.; Koch, Karel T.; Van Straalen, Jan P.; Fischer, Johan; Groenink, Maarten; Bilodeau, Luc; Tijssen, Jan G.P.; Krucoff, Mitchell W.; De Winter, Robbert J.

doi:10.1016/j.amjcard.2009.12.003

« Previous Next »American Journal of Cardiology
Volume 105, Issue 8 , Pages 1065-1069, 15 April 2010

Comparison of Usefulness of N-Terminal Pro-Brain Natriuretic Peptide as an Independent Predictor of Cardiac Function Among Admission Cardiac Serum Biomarkers in Patients With Anterior Wall Versus Nonanterior Wall ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Joost D.E. Haeck, MD
- Department of Cardiology, University of Amsterdam Academic Medical Center, Amsterdam, The Netherlands
- Corresponding author: Tel: (31) 20-566-2609; fax: (31) 20-696-2609
Niels J.W. Verouden, MD
- Department of Cardiology, University of Amsterdam Academic Medical Center, Amsterdam, The Netherlands
Wichert J. Kuijt, MD
- Department of Cardiology, University of Amsterdam Academic Medical Center, Amsterdam, The Netherlands
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
Karel T. Koch, MD, PhD
- Department of Cardiology, University of Amsterdam Academic Medical Center, Amsterdam, The Netherlands
Jan P. Van Straalen, MSc
- Clinical Chemistry, University of Amsterdam Academic Medical Center, Amsterdam, The Netherlands
Johan Fischer, PhD
- Clinical Chemistry, University of Amsterdam Academic Medical Center, Amsterdam, The Netherlands
Maarten Groenink, MD, PhD
- Department of Cardiology, University of Amsterdam Academic Medical Center, Amsterdam, The Netherlands
Luc Bilodeau, MD
- Department of Cardiology, Institut de Cardiology de Montréal, Montréal, Quebec, Canada
Jan G.P. Tijssen, PhD
- Department of Cardiology, University of Amsterdam Academic Medical Center, Amsterdam, The Netherlands
Mitchell W. Krucoff, MD
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
Robbert J. De Winter, MD, PhD
- Department of Cardiology, University of Amsterdam Academic Medical Center, Amsterdam, The Netherlands

Received 24 September 2009; received in revised form 3 December 2009; accepted 3 December 2009. published online 22 February 2010.

The purpose of the present study was to determine the prognostic value of N-terminal pro-brain natriuretic peptide (NT-pro-BNP), among other serum biomarkers, on cardiac magnetic resonance (CMR) imaging parameters of cardiac function and infarct size in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. We measured NT-pro-BNP, cardiac troponin T, creatinine kinase-MB fraction, high-sensitivity C-reactive protein, and creatinine on the patients' arrival at the catheterization laboratory in 206 patients with ST-segment elevation myocardial infarction. The NT-pro-BNP levels were divided into quartiles and correlated with left ventricular function and infarct size measured by CMR imaging at 4 to 6 months. Compared to the lower quartiles, patients with nonanterior wall myocardial infarction in the highest quartile of NT-pro-BNP (≥260 pg/ml) more often had a greater left ventricular end-systolic volume (68 vs 39 ml/m², p <0.001), a lower left ventricular ejection fraction (42% vs 54%, p <0.001), a larger infarct size (9 vs 4 g/m², p = 0.002), and a larger number of transmural segments (11% of segments vs 3% of segments, p <0.001). Multivariate analysis revealed that a NT-pro-BNP level of ≥260 pg/ml was the strongest independent predictor of left ventricular ejection fraction in patients with nonanterior wall myocardial infarction compared to the other serum biomarkers (β = −5.8; p = 0.019). In conclusion, in patients with nonanterior wall myocardial infarction undergoing primary percutaneous coronary intervention, an admission NT-pro-BNP level of ≥260 pg/ml was a strong, independent predictor of left ventricular function assessed by CMR imaging at follow-up. Our findings suggest that NT-pro-BNP, a widely available biomarker, might be helpful in the early risk stratification of patients with nonanterior wall myocardial infarction.