B-type natriuretic peptide as a predictor of ischemia/reperfusion injury immediately after myocardial reperfusion in patients with ST-segment elevation acute myocardial infarction.

Abstract

BACKGROUND:

In animal models of acute myocardial infarction (AMI), B-type natriuretic peptide (BNP) administered before and during coronary occlusion limits infarct size. However, the relation between plasma BNP levels and ischemia/reperfusion injury remains unclear.

METHODS:

302 patients with ST-segment elevation AMI (STEMI) received emergency percutaneous coronary intervention within six hours from the onset. The patients were divided into two groups according to the plasma BNP level before angiography: group L (n=151), BNP ≤ 32.2 pg/ml; group H (n=151), BNP >32.2 pg/ml. The Selvester QRS-scoring system was used to estimate infarct size.

RESULTS:

The rate of ischemia/reperfusion injury immediately after reperfusion, defined as reperfusion ventricular arrhythmias (26% vs. 11%, p=0.001) and ST-segment re-elevation (44% vs. 22%, p=0.008), was higher in group L than in group H. Group L had a greater increase in the QRS score during percutaneous coronary intervention (3.55 ± 0.17 vs. 2.09 ± 0.17, p<0.001) and a higher QRS score 1 h after percutaneous coronary intervention (5.77 ± 0.28 vs. 4.51 ± 0.28, p=0.002). On multivariate analysis, plasma BNP levels in the lower 50th percentile were an independent predictor of reperfusion injury (odds ratio, 2.620; p<0.001). The odds ratios of reperfusion injury according to decreasing quartiles of BNP level, as compared with the highest quartile, were 1.536, 3.692 and 4.964, respectively (p trend=0.002).

CONCLUSIONS:

Plasma BNP level before percutaneous coronary intervention may be a predictor of ischemia/reperfusion injury and the resultant extent of myocardial damage. Our findings suggest that high plasma BNP levels might have a clinically important protective effect on ischemic myocardium in patients with STEMI who receive percutaneous coronary intervention.

• Authors: Kentaro Arakawa, Hideo Himeno, Jin Kirigaya, Fumie Otomo, Kensuke Matsushita, Hidefumi Nakahashi, Satoru Shimizu, Manabu Nitta, Tetsu Takamizawa, Hideto Yano, Mitsuaki Endo, Masahiko Kanna, Kazuo Kimura, Satoshi Umemura
• Journal: European heart journal. Acute cardiovascular care (Eur Heart J Acute Cardiovasc Care) Vol. 5 Issue 1 Pg. 62-70 (Feb 2016) ISSN: 2048-8734 [Electronic] England
• PMID: 25609593 (Publication Type: Journal Article)
• Copyright: © The European Society of Cardiology 2015.

Chemical References

• Biomarkers
• Natriuretic Peptide, Brain

Topics

• Aged
• Aged, 80 and over
• Biomarkers (blood)
• Female
• Humans
• Male
• Middle Aged
• Myocardial Infarction (blood, surgery)
• Myocardial Reperfusion (adverse effects, methods)
• Natriuretic Peptide, Brain (blood)
• Percutaneous Coronary Intervention (adverse effects, methods)
• Predictive Value of Tests
• Reperfusion Injury (blood)