Prehospital electrocardiographic acuteness score of ischemia is inversely associated with neurohormonal activation in STEMI patients with severe ischemia.

Abstract

BACKGROUND:

Elevated levels of N-terminal pro brain natriuretic peptide (NT-proBNP) are associated with adverse cardiovascular outcome after ST elevation myocardial infarction (STEMI). We hypothesized that decreasing acuteness-score (based on the electrocardiographic score by Anderson-Wilkins acuteness score of myocardial ischemia) is associated with increasing NT-proBNP levels and the impact of decreasing acuteness-score on NT-proBNP levels is substantial in STEMI patients with severe ischemia.

METHODS:

In 186 STEMI patients treated with primary percutaneous coronary intervention (pPCI), the severity of ischemia (according to Sclarovsky-Birnbaum severity grades of ischemia) and the acuteness-score were obtained from prehospital ECG. Patients were classified according to the presence of severe ischemia or non-severe ischemia and acute ischemia or non-acute ischemia. Plasma NT-proBNP (pmol/L) was obtained after pPCI within 24hours of admission and was correlated with the acuteness-score.

RESULTS:

NT-proBNP levels were median (25th-75th interquartile) 112 (51-219) pmol/L in patients with non-severe ischemia (71.5%) and 145 (79-339) in patients with severe ischemia (28.5%) (p=0.074). NT-proBNP levels were highest in patients with severe and non-acute ischemia compared to those with severe and acute ischemia (182 (98-339) pmol/L vs 105 (28-324) pmol/L, p=0.012). There was a negative correlation between acuteness-score and log(NT-proBNP) in patients with severe ischemia (r=0.395, p=0.003), which remained significant in multilinear regression analysis (β=-0.155, p=0.007). No correlation was observed between the acuteness-score and log(NT-proBNP) in patients with non-severe ischemia (p=0.529) or in the entire population (p=0.187).

CONCLUSION:

In STEMI patients with severe ischemia, neurohormonal activation is inversely associated with ECG patterns of acute myocardial ischemia.

• Authors: Yama Fakhri, Mikkel Malby Schoos, Maria Sejersten, Mads Ersbøll, Nana Valeur, Lars Køber, Christian Hassager, Galen S Wagner, Jens Kastrup, Peter Clemmensen
• Journal: Journal of electrocardiology (J Electrocardiol) 2017 Jan - Feb Vol. 50 Issue 1 Pg. 90-96 ISSN: 1532-8430 [Electronic] United States
• PMID: 27887720 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2016 Elsevier Inc. All rights reserved.

Chemical References

• Biomarkers
• Peptide Fragments
• pro-brain natriuretic peptide (1-76)
• Natriuretic Peptide, Brain

Topics

• Acute Disease
• Biomarkers (blood)
• Denmark
• Electrocardiography (methods, statistics & numerical data)
• Emergency Medical Services (statistics & numerical data)
• Female
• Humans
• Incidence
• Male
• Middle Aged
• Myocardial Ischemia (blood, diagnosis, epidemiology)
• Natriuretic Peptide, Brain (blood)
• Peptide Fragments (blood)
• Reproducibility of Results
• Risk Assessment (methods)
• Risk Factors
• ST Elevation Myocardial Infarction (blood, diagnosis, epidemiology)
• Sensitivity and Specificity
• Severity of Illness Index