우종신, 김원, 황승준, 권성진,하상진, 김석연, 김수중, 김우식, 김명곤, 김권삼, 배종화, Korean Acute Myocardiac Infarction Registry (KAMIR)연구자 |
Background: hs-C reactive protein (hs-CRP) and N-terminal pro– brain natriuretic peptide (NT-proBNP) are an independent predictor of cardiac events in patients with ACS. Little is known, however, about the relationships between multimarker approach and success of thrombolysis, as well as short- and long-term mortality. The aim of this study was to evaluate the usefulness of combining serum NT-proBNP and hs-CRP to predict success rate and prognosis after fibrinolytic treatment in patients with ST-elevation myocardial infarction (STEMI)
Methods: We analyzed data of 489 patients (389 males, 89%; mean age 58 ± 12 years) who received intravenous thrombolysis because of STEMI from the KAMIR database. Combined assessment of hs-CRP and NT-proBNP compared with single-marker evaluation in patients with coronary artery disease (CAD) was performed.
Results: By univariate analysis, TIMI grade 3 flow in the infarct-related artery was significantly achieved in higher half hs-CRP [hazard ratio (HR), 1.97; 95% confidence interval (CI), 1.25-3.11], higher half NT-proBNP (HR 1.59, 95% CI 1.07-2.39), higher half maximal CK level (HR, 2.55; 95% CI, 1.68-3.87) and lesion type C (HR 2.64, 95% CI 1.76 – 3.97). The number of elevated biomarkers showed a significant predictor of the composite endpoint after adjustment for known clinical predictors (such as age, sex, diabetes, hypertension, etc): patients with one and two elevated biomarkers had a 3.8- (P<0.05) and 8.8- (P<0.01) fold increase in the risk of death, repeated MI, or target vessel revascularization by 6 months (figure).
Conclusions: A simple multimarker strategy may be a predictor of reperfusion failure in fibrinolytic treatment and allow risk stratification over a broad range of short- and long-term mortality.
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