Abstract 3436: Preprocedural N-Terminal Pro-B-Type Natriuretic Peptide Predicts Angiographic No-Reflow Phenomenon During Stent Implantation in Patients with Acute Myocardial Infarction
Background: The no-reflow phenomenon after primary percutaneous coronary intervention (PCI) is associated with greater infarct size, worse functional recovery, and higher incidence of complication in acute ST-elevation myocardial infarction (STEMI). The aim of this study was to assess the relation between preprocedural N-terminal pro-B-type natriuretic peptide (NT-proBNP) and angiographic no-reflow phenomenon.
Methods: We measured serum NT-proBNP level in 106 consecutive AMI patients (63.7±11.9 years, male 72 %) on admission and before PCI. Angiographic no-reflow after PCI was defined as Thrombolysis in Myocardial Infarction (TIMI) flow grade <3.
Results: The baseline clinical characteristics including time from the chest pain onset between the groups with no-relow group (n=56) and normal reflow group (n=50, TIMI flow grade=3) are similar. The level of NT-proBNP was significantly higher in the no-reflow group than that in the normal reflow group (2840.3±5335.6 vs. 377.5±600.7 pg/mL, p=0.001). Also, the level of high-sensitivity C-reactive protein (hsCRP), monocyte, and troponin-T were significantly higher in the no-reflow group than those in the normal reflow group. There were no significant differences in the distribution of target vessel or number of receiving intravenous or intracoronary abciximab between the groups. In no-reflow group, NT-proBNP level was much higher in patients with TIMI flow grade 0 (n=38, 3274.3±6265.9 pg/mL) than that in patients with TIMI flow grade I or II (n=18, 1924.1±2311.3 pg/mL). The area under the receiver-operating characteristic (ROC) curve for NT-proBNP level was 0.79, and the optimal cut-off value identified by ROC analysis was 500 pg/mL. At the standard cutpoint of >500 pg/mL, elevated NT-proBNP level shows high probability of no-reflow phenomenon (odd ratio, 5.84; 95% CI, 2.43 to 14.06; p<0.001). In multivariate analysis, the NT-proBNP was an independent predictor for no-reflow phenomenon along with troponin-T, whereas hsCRP and monocyte were not.
Conclusion: Preprocedural NT-proBNP is an strong predictor for the development of no-reflow phenomenon after PCI in patients with acute STEMI.