N-terminal pro-B-type natriuretic peptide levels after hospital discharge in patients with acute myocardial infarction for predicting long term outcome

Background N-terminal-pro-brain natriuretic peptide(NT-pro-BNP)is associated with worse outcome in patients with acute myocardial infarction(AMI). However,the role of short-term follow-up of NT-pro-BNP level remains unclear. Methods Three hundred and sixty-two patients diagnosed with AMI were retrospectively enrolled in this study from March 2014 to March 2017 in our center. Blood samples were obtained at initial admission and again within 1 month after hospital discharge. The univariate and multivariate cox regression analyses including significant covariables were performed on NT-pro-BNP level at admission,discharge,or change from admission to discharge to predict adverse cardiovascular events(MACE)as study endpoints. Results There were 211 cases in NT-pro-BNP decrease group,while 151 cases in NT-pro-BNP increase group. The median follow-up was 365 days(interquartile range[IQR],322-861 days). After adjusting the covariables in the multiple logistic regression analysis,follow-up NT-pro-BNP level was still a significant independent predictor for MACE(OR,1.395;95% CI,1.102-1.869,P=0.005). However,the initial NT-pro-BNP level or change of NT-pro-BNP level had no significant predictive value for MACE. Conclusions A short-term follow-up NT-pro-BNP level after hospital discharge is a powerful prognostic biomarker for MACE in patients with AMI.

Increased lipoprotein (a) level is independently associated with the severity of coronary artery disease

Background Increased serum level of lipoprotein （a） （Lp （a）） is associated with atherosclerosis. Whether increased Lp （a） level is independently associated with the severity of coronary artery disease （CAD） is un- clear. Methods Subjects were enrolled and received coronary angiography to assess the number of stenosed coronary artery. The subjects with CAD were divided into non-significant （〈 50% stenosis）, single and multi- vessel stenosis （ ≥ 50 % stenosis） groups. Parameters of interest at baseline were collected. Statistical analyses were performed to evaluate the relationship between Lp （a） level and CAD severity. Results Totally 745 populations were enrolled and diagnosed as CAD （n = 605） or without CAD （n = 140） on the basis of an- giography examination. As compared to the subjects without CAD, serum levels of Lp （a） and CRP, and the percentages of subjects with smoking or diabetes were significantly higher in subjects with CAD. In contrast, serum levels of HDL-C and Apo-A were significantly lower in subjects with CAD as compared to subjects without CAD. In comparison of subjects with non-significant stenosis （serum Lp（a） level, 170.0±19.7 mg/ dL）, serum Lp（a） level was significantly higher in subjects with single （245.5 ± 22.3 mg/dL） or multiple vessel stenoses （265.8 ± 14.0 mg/dL）. With multivariate regression analyses, after adjusted for age, gender, smoking, family history and hypertension, there was still significant association between serum Lp（a） level and the number of coronary artery stenosis. After additional adjustment for diabetes, HbAlc, total cholesterol, LDL-C, Apo-A, uric acid and CRP, Lp（a） remained strongly associated with CAD severity. Conclusion Serum Lp（a） level was significantly associated with the severity of coronary artery stenosis, which may add the value on cardiovascular risk evaluation.