Abstract | OBJECTIVES: BACKGROUND: METHODS: The Assessment of Pexelizumab in Acute Myocardial Infarction trial tested pexelizumab treatment in STEMI patients presenting within 6 hours of symptom onset who were to undergo primary percutaneous coronary intervention. We studied 64 patients within this trial according to a prespecified substudy that included paired core laboratory delayed-enhancement CMR at days 3 and 90 as well as plasma N-terminal pro- B-type natriuretic peptide ( NT-proBNP; in picograms per milliliter) measured at randomization and 24 hours. A multivariable model predicting day 90 left ventricular ejection fraction (LVEF) was developed from clinical, biomarker, and imaging findings. RESULTS: Patients had a median age of 60 years (52-68), 89% were male, and 60% had anterior STEMI. Time from symptom onset to percutaneous coronary intervention was 3 hours. The median baseline LVEF was 48% (38%-56%) and was 50% (40%-54%) at 90 days: 7 patients (11%) had an LVEF <35% at 90 days. Patients with a lower 90-day LVEF (as a continuous variable) had a higher 24-hour NT-proBNP (P = .02) and a larger baseline infarct size by CMR (median 15% LV [8%-20% LV]) (P < .01). Microvascular obstruction (no reflow) was greater as measured by CMR (median 2.8% [1.4%-6.1%]) in patients with a lower 90-day LVEF (P < .01). Median baseline and 24-hour NT-proBNP levels were 94 pg/mL (54-292 pg/mL) and 1,448 pg/mL (958-2,599 pg/mL), respectively. In a multivariable model with clinical, biomarker, and imaging variables, only 3 variables independently predicted 90-day LVEF: 24-hour NT-proBNP, baseline CMR infarct size, and microvascular obstruction. CONCLUSIONS: Three key pathophysiologic variables of the post- STEMI myocardium measuring baseline infarct size and the extent of microvascular obstruction on CMR and wall tension (24-hour NT-proBNP) independently predicted 90-day LVEF. Further studies linking these measures with earlier use of clinical therapies may be warranted.
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Authors | Justin A Ezekowitz, Paul W Armstrong, Christopher B Granger, Pierre Theroux, Amanda Stebbins, Raymond J Kim, Manesh R Patel |
Journal | American heart journal
(Am Heart J)
Vol. 160
Issue 2
Pg. 272-8
(Aug 2010)
ISSN: 1097-6744 [Electronic] United States |
PMID | 20691832
(Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
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Copyright | Copyright 2010 Mosby, Inc. All rights reserved. |
Chemical References |
- Antibodies, Monoclonal
- Antibodies, Monoclonal, Humanized
- Biomarkers
- Peptide Fragments
- Protein Precursors
- Single-Chain Antibodies
- pro-brain natriuretic peptide (1-76)
- Natriuretic Peptide, Brain
- pexelizumab
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Topics |
- Aged
- Antibodies, Monoclonal
(therapeutic use)
- Antibodies, Monoclonal, Humanized
- Biomarkers
(blood)
- Coronary Angiography
- Female
- Humans
- Magnetic Resonance Imaging, Cine
- Male
- Middle Aged
- Myocardial Infarction
(complications, drug therapy, pathology, physiopathology)
- Natriuretic Peptide, Brain
(blood)
- Peptide Fragments
(blood)
- Protein Precursors
(blood)
- Risk Assessment
- Single-Chain Antibodies
(therapeutic use)
- Stroke Volume
- Ventricular Dysfunction, Left
(epidemiology)
- Ventricular Remodeling
|