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ȣ - 530868 18 |
| Early invasive intervention improves the prognosis of patients with non-ST-segment elevation myocardial infarction who have elevated N terminal pro B-type natriuretic peptide on admission |
| 가톨릭의대, 영남의대¹ , 전남의대² ,아산병원³ |
| 추은호, 승기배, 정욱성, 장기육, 박훈준, 서석민, 엄재선, 김지희, 고윤석, 정우백, 박만원, 윤성규,최민석, 김영조¹ ,정명호² ,박승정³, 외 KAMIR 연구자 |
BACKGROUND: Although early invasive intervention did not improve the overall outcomes of patients with non-ST-segment elevation myocardial infarction (NSTEMI), it improved the prognosis of high-risk patients with NSTEMI. N-terminal pro B-type natriuretic peptide (NTproBNP) is useful in predicting the outcomes following NSTEMI. Thus we hypothesized that early invasive intervention may improve the outcomes of patients with NSTEMI and elevated NTproBNP on admission. METHODS: We analyzed 1335 consecutive patients with NSTEMI who had undergone percutaneous coronary intervention (PCI) within 48 hours from November 2005 to Jan 2008, using Korean Acute Myocardial Infarction Registry. Primary outcome was major adverse cardiac events (MACE) which include cardiac death, nonfatal MI and repeat revascularization at 30days after PCI. RESULTS: Multiple logistic regression analysis revealed that risk factors for MACE at 30days were high log-transformed NTproBNP (odds ratio[OR] 1.604, 95% confidence interval[CI] 1.137 to 2.262, p=0.007), delayed PCI (OR 1.051, 95% CI 1.011 to 1.093, p=0.011). The receiver operating curve for NTproBNP yielded an area under the curve (AUC) of 0.764 (95% CI 0.689 to 0.839, p<0.001), while for TIMI risk score the AUC was 0.613 (95% CI 0.521 to 0.704, p=0.029). All patients were stratified based on the time lapse between admission and PCI: group 1, <6 hours (n = 357, 2.56 ± 1.49 hours); group 2, > or =6 and <24 hours (n = 582, 16.0 ± 5.13 hours); group 3, > or =24 hours and <48 hours (n = 397, 35.2 ± 7.87 hours). Patients in group I had higher peak cardiac enzyme, more complex coronary artery disease and lower blood pressure. In patients with high NTproBNP (>1000ng/L, n = 447), early invasive intervention was associated with significantly lower rates of MACEs at 30days (group 1: 0.8%, group 2: 2.2%, group 3: 6.0% ; p=0.032) but not in patients with low NTproBNP. Even at 6 months, early invasive intervention significantly reduced MACE (group 1: 1.5%, group 2: 2.7%, group 3: 10.4%; p=0.001). CONCLUSION: Early invasive intervention improves clinical outcomes in NSTEMI patients with elevated NTproBNP on admission.
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