| 홍서나, 정명호, 안영근, 채성철, 허승호, 성인환, 김종현, 홍택종, 구본권, 채제건, 채동훈, 윤정한, 배장호, 나승운, 류제영, 김두일, 김기식, 김병옥, 오석규, 채인호, 이명용, 정경태, 조명찬, 김종진, 김영조, 외 Korea Acute Myocardial Infarction Registry Investigators |
Background: Obesity, as indexed by elevated body mass index (BMI), affects N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels, with lower circulating levels in those with a higher BMI. To investigate the relationship between BMI and NT-proBNP level, and resultant prognostic capacity in patients with acute ST-segment elevation myocardial infarction (STEMI) according to obesity status was analyzed.
Methods: A total of 2,826 consecutive patients (62.5±12.4 years, male 74.8 %) with STEMI who were registered in Korea Acute Myocardial Infarction Registry from Nov. 2005 to Dec. 2007 were enrolled. All of the patients underwent percutaneous coronary intervention (PCI). The patients were divided into three groups according to BMI [group I: BMI < 25 kg/m2, n=1811; group II: BMI ≥ 25 kg/m2, (group IIa: BMI 25-29.9 kg/m2, n=907; group IIb: BMI ≥ 30 kg/m2, n=108)]. Primary study outcomes include in-hospital death (IHD), major adverse cardiac events (MACE: cardiac death, non cardiac death, MI, repeat PCI, and coronary artery bypass surgery) at 6 and 12 months after PCI.
Results: Age, sex, glomerular filtration rate (GFR), and left ventricular ejection fraction (LVEF) were similar among three groups. NT-proBNP level was the lowest in group IIb (2157.2±4934.3 pg/mL in group I, 1358.9±3904.4 pg/mL in group IIa, 862.9±2322.2 pg/mL in group IIb, p <0.001). The level of NT-proBNP was negatively correlated with BMI, GFR, and LVEF (r=-0.205, p<0.001; r=-0.242, p<0.001; r=-0.412, p<0.001, respectively) and positively correlated with age (r=0.401, p<0.001). NT-proBNP remained an independent predictor of MACE after correction for age, BMI, GFR, and LVEF. The level of NT-proBNP was an independent predictor of IHD (OR, 11.22, 95% CI 2.67-47.09, p=0.001), and 6 months (OR, 1.48, 95% CI 1.02-2.14, p=0.037) and 12 months MACE (OR, 1.52, 95% CI 1.08-2.15, p=0.016) in group I. Also, the level of NT-proBNP was an independent predictor of IHD (OR, 5.57, 95% CI 2.14-15.45, p=0.001) and 6 months (OR, 1.77, 95% CI 1.15-2.73, p=0.010), and 12 months MACE (OR, 1.88, 95% CI 1.24-2.88, p=0.003), in group II.
Conclusion: Age, renal function, BMI, and LVEF affect significantly NT-proBNP levels in patient with acute STEMI. NT-proBNP retained an independent prognostic factor in patients with acute STEMI treated PCI to obesity status.
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