Abstract 13184: An Elevated Level of N-terminal Pro-brain Natriuretic Peptide is Associated With the Development of Good Collateral Circulation in Patients Undergoing Primary Percutanous Coronary Intervention After St Segment Elevation Myocardial Infarction?
Background: Although N-terminal pro-brain natriuretic peptide (NT-proBNP) is released by ventricular myocardium as a result of increased myocardial wall stress, NT-proBNP was recently demonstrated to be a potential stimulator of angiogenesis and arteriogenesis. However, little is known about the correlation between NT-proBNP level and collateral formation in patients undergoing primary percutaneous coronary intervention (PCI) after ST segment elevation myocardial infarction (MI).
Methods: Between November 2005 and November 2011, 857 eligible patients were analyzed in this study. Serum NT-proBNP levels were measured at the time of admission. Collateral circulation (CC) was graded according to Rentrop’s classification. Grade 0 and 1 are regarded as poor, and grade 2 and 3 are regarded as good CC.
Results: Overall, 429 (50.1%) had angiographic evidence of CC including 265 (30.9%) with grade 1 and 164 (19.1%) with grade 2/3. The patients with good CC had a more typical chest pain, preinfarction angina, previous coronary heart disease (CHD), non-left anterior descending artery (LAD)-related MI, multivessel disease, pre-TIMI flow grade 0/1, and longer symptom-to-door (STD) time. Log-transformed NT-proBNP level was positively correlated with Rentrop collateral score (r=0.148, p<0.001). Log-transformed NT-proBNP levels were significantly higher in patients with grade 2/3 CC (6.13±2.01 pg/mL) compared with grade 1 (5.68±2.04 pg/mL) and grade 0 CC (5.36±1.91 pg/mL), respectively (p <0.001). In the receiver-operator characteristic curve of log NT-proBNP, the area under the curve of log NT-proBNP for predicting CC was 0.600 (sensitivity 54.9% and specificity 64.8%), and optimum cut-off value was 6.04 pg/mL. In multivariate logistic regression model, log-transformed NT-proBNP ≥6.04 pg/mL (Odds ratio [OR] 2.123, p<0.001) in addition to previous CHD (OR 1.835, p=0.031), pre-TIMI flow grade 0/1 (OR 3.080, p<0.001), non-LAD-related MI (OR 2.102, p<0.001) was an independent predictor of good CC after adjusting for confounding variables.
Conclusions: An elevated level of serum NT-proBNP is independently associated with collateral development in patients undergoing primary PCI.
Author Disclosures: J. Lee: None. J. Kim: None. S. Jang: None. S. Park: None. M. Bae: None. D. Yang: None. H. Park: None. Y. Cho: None. S. Chae: None.
- © 2014 by American Heart Association, Inc.