BNP对急性心肌梗死患者行急诊冠脉介入治疗预后价值

Prognostic Value of Brain Natriuretic Peptide in Patients with Acute Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention

目的观察ST段抬高的急性心肌梗死(STEAMI)患者接受急诊直接冠状动脉介入治疗(primary PCI)后的脑利钠肽(BNP)水平对长期预后的价值。方法连续入选2005年7月-2006年3月之间,发病后12h之内接受急诊直接PCI治疗的ST段抬高急性心肌梗死患者92例,采用荧光免疫抗原抗体结合方法测定发病后第24h血浆BNP水平。根据BNP浓度分为3组:A组<100pg/mL,B组100～400pg/mL,C组>400pg/mL。收集住院期间的临床资料,并随访1年。结果①C组年龄明显高于A组(P(0·01)。②冠状动脉造影结果中B、C组梗死相关血管(IRA)中左前降支(LAD)所占比例高于A组(P(0·05),并且多支血管病变比例也明显高于A组(P(0·01)。③1年内病死率,C组明显高于A、B组(P(0·01),进行多因素logistic回归分析,血浆BNP浓度是AMI后1年病死率的独立预测因子。结论接受急诊直接冠状动脉介入治疗的ST段抬高的急性心肌梗死患者的早期血浆脑利钠肽水平可作为1年后病死率的预测因子。

Objective To evaluate the value of brain natriuretic peptide （BNP） on predicting long -term mortality after hospital discharge in patients with ST elevated acute myocardial infarction （STEAMI） treated with primary percutaneous coronary intervention （PCI）. Methods From July 2005 to March 2006, consecutive 92 patients with STEAMI, successfully reperfused by primary PCI within 12 hours were included in this study. BNP plasma concentration levels were measured by fluorescence immunoassay at 24h from onset, and patients were divided into 3 groups：group A （ 〈 100 pg/ml） ;group B （100 -400 pg/ml） ;group C （〉400pg/ml）. The clinical data was collected during hospitalization and all patients were followed up for 12 months. Results （1）Patients of group C were significantly older than group B,C（ P 〈 0.01 ）. （2）Compared with group A,patients in group B,C had more multi - vessel diseases （ P 〈 0. 01 ） and more left anterior descending（LAD） artery diseases in infarct -related coronary artery（IRA） （ P 〈 0.05 ）. （3） There was significantly higher 1 -year mortality in group C compared with group A,B （ P 〈0. 01）. By multivariate analysis, BNP plasma concen- tration was an independent predictor of long - term mortality （ P 〈 0. 05 ）. Conclusion Early - phase BNP plasma concentrations after successful PCI in patients with ST elevated acute myocardial infarction may be a strong predictor for 1 -year mortality.