Document Detail


Serum B-type natriuretic peptide on admission can predict the 'no-reflow' phenomenon after primary drug-eluting stent implantation for ST-segment elevation myocardial infarction.
MedLine Citation:
PMID:  19144424     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The angiographic 'no-reflow' phenomenon after primary percutaneous coronary intervention (PPCI) is associated with a poor short-term and long-term clinical prognosis of ST-elevation myocardial infarction (STEMI). Although the increasing use of primary drug-eluting stent (DES) deployment for STEMI resulted in reduced adverse clinical outcomes, the prevalence of no-reflow has been unchanged. The purpose of our study was to evaluate the predictors for no-reflow for STEMI and identify such high-risk patients in the DES era. METHODS: The study prospectively enrolled 300 consecutive STEMI patients (80% men; 57+/-11 years) who underwent PPCI within 12 h of symptom onset. The no-reflow phenomenon was defined as an angiographic outcome of Thrombolysis In Myocardial Infarction (TIMI) grade <3 without accompanying mechanical factors. RESULTS: Compared to normal reflow patients, no-reflow patients (n=15, 5% of the total study population) were older (64+/-13 vs. 57+/-11 years; P=0.019), transferred to hospital later (7.1+/-3.2 vs. 4.5+/-3.8 h; P=0.011), and had a higher TIMI risk score (5.5+/-2.0 vs. 3.8+/-2.2; P=0.004). B-type natriuretic peptide (BNP), high sensitivity C-reactive protein, and serum creatinine levels were higher in the no-reflow than the normal reflow group. Multivariate analysis (including clinical, angiographic and procedural variables with a P<0.2 in univariate analysis) showed that high BNP level on admission was the only independent predictor of no-reflow. The area under the receiver-operating characteristics curve analysis value for BNP was 0.786. BNP > or =90 pg/ml showed a sensitivity of 80% and a specificity of 70% for predicting no-reflow after primary DES implantation (OR 14.953, 95% CI 3.131-71.419, P=0.001). CONCLUSIONS: Angiographic 'no-reflow' phenomenon after primary DES implantation for STEMI can be predicted by BNP levels on admission. BNP-guided approach may be useful in identifying patients at high risk of the no-reflow phenomenon after primary stenting.
Authors:
Young-Hoon Jeong; Won-Jang Kim; Duk-Woo Park; Bong-Ryong Choi; Seung-Whan Lee; Young-Hak Kim; Cheol Whan Lee; Myeong-Ki Hong; Jae-Joong Kim; Seong-Wook Park; Seung-Jung Park
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2009-01-13
Journal Detail:
Title:  International journal of cardiology     Volume:  141     ISSN:  1874-1754     ISO Abbreviation:  Int. J. Cardiol.     Publication Date:  2010 May 
Date Detail:
Created Date:  2010-05-21     Completed Date:  2010-09-14     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8200291     Medline TA:  Int J Cardiol     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  175-81     Citation Subset:  IM    
Copyright Information:
Copyright 2008 Elsevier Ireland Ltd. All rights reserved.
Affiliation:
Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, South Korea.
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MeSH Terms
Descriptor/Qualifier:
Age Factors
Angioplasty, Transluminal, Percutaneous Coronary*
Biological Markers / blood
C-Reactive Protein / analysis
Coronary Angiography
Creatinine / blood
Drug-Eluting Stents*
Female
Humans
Male
Middle Aged
Myocardial Infarction / blood,  therapy*
Natriuretic Peptide, Brain / blood*
No-Reflow Phenomenon / blood*
Patient Admission
Patient Transfer
Prospective Studies
ROC Curve
Risk Assessment
Chemical
Reg. No./Substance:
0/Biological Markers; 114471-18-0/Natriuretic Peptide, Brain; 60-27-5/Creatinine; 9007-41-4/C-Reactive Protein

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