Comparison of the Usefulness of N-Terminal Pro-Brain Natriuretic Peptide to Other Serum Biomarkers as an Early Predictor of ST-Segment Recovery After Primary Percutaneous Coronary Intervention

Verouden, Niels J.W.; Haeck, Joost D.E.; Kuijt, Wichert J.; van Geloven, Nan; Koch, Karel T.; Henriques, José P.S.; Baan, Jan; Vis, Marije M.; van Straalen, Jan P.; Fischer, Johan; Piek, Jan J.; Tijssen, Jan G.P.; de Winter, Robbert J.

doi:10.1016/j.amjcard.2009.12.002

« Previous Next »American Journal of Cardiology
Volume 105, Issue 8 , Pages 1047-1052, 15 April 2010

Comparison of the Usefulness of N-Terminal Pro-Brain Natriuretic Peptide to Other Serum Biomarkers as an Early Predictor of ST-Segment Recovery After Primary Percutaneous Coronary Intervention

Niels J.W. Verouden, MD
- Department of Cardiology, Academic Medical Center, University of Amsterdam Academic Medical Center, Amsterdam, The Netherlands
Joost D.E. Haeck, MD
- Department of Cardiology, Academic Medical Center, University of Amsterdam Academic Medical Center, Amsterdam, The Netherlands
Wichert J. Kuijt, MD
- Department of Cardiology, Academic Medical Center, University of Amsterdam Academic Medical Center, Amsterdam, The Netherlands
Nan van Geloven, MSc
- Department of Cardiology, Academic Medical Center, University of Amsterdam Academic Medical Center, Amsterdam, The Netherlands
Karel T. Koch, MD, PhD
- Department of Cardiology, Academic Medical Center, University of Amsterdam Academic Medical Center, Amsterdam, The Netherlands
José P.S. Henriques, MD, PhD
- Department of Cardiology, Academic Medical Center, University of Amsterdam Academic Medical Center, Amsterdam, The Netherlands
Jan Baan, MD, PhD
- Department of Cardiology, Academic Medical Center, University of Amsterdam Academic Medical Center, Amsterdam, The Netherlands
Marije M. Vis, MD
- Department of Cardiology, Academic Medical Center, University of Amsterdam Academic Medical Center, Amsterdam, The Netherlands
Jan P. van Straalen
- Department of Clinical Chemistry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
Johan Fischer, PhD
- Department of Clinical Chemistry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
Jan J. Piek, MD, PhD
- Department of Cardiology, Academic Medical Center, University of Amsterdam Academic Medical Center, Amsterdam, The Netherlands
Jan G.P. Tijssen, PhD
- Department of Cardiology, Academic Medical Center, University of Amsterdam Academic Medical Center, Amsterdam, The Netherlands
Robbert J. de Winter, MD, PhD
- Department of Cardiology, Academic Medical Center, University of Amsterdam Academic Medical Center, Amsterdam, The Netherlands
- Corresponding author: Tel: (31) 20-566-9111; fax: (31) 20-696-2609

Received 30 September 2009; received in revised form 1 December 2009; accepted 1 December 2009. published online 22 February 2010.

Data on the ability of serum biomarkers to predict microvascular obstruction by ST-segment recovery after primary percutaneous coronary intervention (PCI) is largely absent. Therefore, we determined the association between 5 serum biomarkers, obtained before emergency coronary angiography, and immediate ST-segment recovery in patients who had undergone primary PCI for ST-segment elevation myocardial infarction. We measured N-terminal pro-brain natriuretic peptide (NT-pro-BNP), cardiac troponin T, creatinine kinase-MB fraction, high-sensitivity C-reactive protein, and serum creatinine from blood samples obtained through the arterial sheath at the start of primary PCI. Serial 12-lead electrocardiograms were recorded in the catheterization laboratory before arterial puncture and at the end of the PCI. ST-segment recovery was defined as incomplete if <50%. Of 662 included patients with ST-segment elevation myocardial infarction, 338 (51%) had incomplete ST-segment recovery. An elevated NT-pro-BNP level (≥608 ng/L) was the strongest predictor of incomplete ST-segment recovery (adjusted odds ratio 2.6, 95% confidence interval 1.6 to 4.1; p <0.001) compared to other serum biomarkers and clinical predictors. An elevated NT-pro-BNP level was more strongly predictive in patients without a history of coronary artery disease or hypertension (adjusted odds ratio 4.7, 95% confidence interval 2.4 to 9.2; p <0.001). NT-pro-BNP was the best contributor to both net reclassification (0.43; p <0.001) and integrated discrimination improvement (0.04; p <0.001) when added to a multivariate model with clinical predictors of incomplete ST-segment recovery. In conclusion, NT-pro-BNP was the strongest independent predictor of ST-segment recovery at the end of primary PCI for ST-segment elevation myocardial infarction compared to the other serum biomarkers reflecting myocardial cell damage, renal function, and inflammation.