急性心肌梗死急诊经皮冠状动脉介入术患者N-端脑钠肽前体对冠状动脉病变程度及预后的意义

Significance of N-terminal pro-brain natriuretic peptide for severity and prognosis of coronary artery lesions in patients with acute myocardial infarction undergoing emergent PCI

目的探讨N-端脑钠肽前体(Nt-proBNP)水平在急性心肌梗死(AMI)急诊经皮冠状动脉介入术(PCI)患者中与冠状动脉病变程度及预后的关系。方法选取2016年1月至2017年1月在山西医科大学附属汾阳医院心血管内科住院,发病12 h内行急诊PCI术的AMI患者49例作为AMI组,同期入院的有非典型胸痛表现,冠状动脉造影结果正常者47例作为对照组。采用Gensini积分法进行冠状动脉病变程度判定,检测入院后即刻、24 h、1周、1个月血清Nt-proBNP水平,观察6个月内不良心血管事件(MACE)发生的情况。结果与对照组比较,AMI组Nt-proBNP水平在即刻[(280±373)pg/ml与(152±76)pg/ml,P<0.05]、24 h[(1 609±2 656)pg/ml与(148±67)pg/ml,P<0.01]、1周[(1 488±1 447)pg/ml与(135±54)pg/ml,P<0.01]、1个月(784±837)pg/ml与(134±51)pg/ml,P<0.01]均显著升高。AMI组血清Nt-proBNP在入院即刻、24 h、1周、1个月均与冠状动脉病变程度具有显著相关性(r值分别为0.363 7、0.652 6、0.820 2、0.817 6;P均<0.01)。AMI组中,与未发生MACE患者相比,发生MACE患者Nt-proBNP水平在即刻[(558±479)pg/ml与(180±270)pg/ml,P<0.01]、24 h(4 010±4 348)pg/ml与(742±525)pg/ml,P<0.01]、1周[(3 465±1350)pg/ml与(829±672)pg/ml,P<0.01]、1个月[(1 963±829)pg/ml与(424±391)pg/ml,P<0.01]均显著升高。结论行急诊PCI术的AMI患者Nt-proBNP与冠状动脉病变程度呈正相关,对6个月内的MACE事件具有预测作用。

Objective To investigate the relationship between the level of N-terminal probrain natriuretic peptide (Nt-proBNP) and the severity and prognosis of coronary artery lesions in the patients with acute myocardial infarction (AMI) undergoing emergent percutaneous coronary intervention (PCI). Methods A total of 49 AMI patients, who underwent emergent PCI within 12 hours of onset in the Department of Cardiovascular Disease, Fenyang Hospital Affiliated to Shanxi Medical University between January 2016 and January 2017, were included as the AMI group. A contemporary cohort of 47 patients with atypical chest pain and normal coronary angiography were included as the control group. The Gensini score was used to determine the severity of coronary artery lesions. The serum Nt-proBNP level was measured immediately after admission, and at 24 h, 1 week, and 1 month after admission. The major adverse cardiovascular events (MACE) were determined within 6 months. Results Compared with the control group, the level of Nt-proBNP in the AMI group significantly increased immediately [(280±373)pg/ml vs(152±76)pg/ml, P<0.05], and at 24 h [(1 609±2 656)pg/ml vs(148±67)pg/ml, P<0.01], 1 week [(1 488±1 447)pg/ml vs(135±54)pg/ml, P<0.01], and 1 month [(784±837)pg/ml vs(134±51)pg/ml, P<0.01] after admission. The serum Nt-proBNP level in the AMI group was significantly correlated with the severity of coronary artery lesions immediately after admission, and at 24 h, 1 week, 1 month after admission (r=0.363 7, 0.652 6, 0.820 2 and 0.817 6, respectively;all P<0.01). In the AMI group, the level of Nt-proBNP in the patients with MACE immediately after admission [(558±479)pg/ml vs(180±270)pg/ml, P<0.01], and at 24 h [(4 010±4 348)pg/ml vs(742±525)pg/ml, P<0.01], 1 week [(3 465±1 350)pg/ml vs(829±672)pg/ml, P<0.01] and 1 month [(1 963±829)pg/ml vs(424±391)pg/ml, P<0.01] after admission sig-nificantly increased compared with that in patients without MACE. Conclusion The Nt-proBNP level in AMI patients undergoing emergent PCI is positively correlated with the severity of coronary artery lesions, and it is predictive for MACE events within 6 months.