The influencing factors of serum NT-proBNP level in elderly patients with acute myocardial infarction after PCI and influence on short-term prognosis_Chinese Journal of Evidence-Based Medicine

Authors：

 QIAN Jin ¹ , WANG Fengyan ²

1. Zhengzhou Central Hospital, Zhengzhou 450000, P. R. China;
2. Henan Provincial Staff Hospital, Zhengzhou 450003, P. R. China;

Corresponding author：

QIAN Jin, Email: qianjinggg147@163.com

Keywords：

Acute myocardial infarction; Elderly; NT-proBNP; Percutaneous coronary intervention; Influencing factors; Major adverse cardiovascular events

DOI：

10.7507/1672-2531.202304038

Video：

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Objective To investigate the influencing factors of serum NT-proBNP level in elderly patients with acute myocardial infarction (AMI) after PCI, and to analyze its predictive value for the short-term prognosis of patients. Methods A total of 98 elderly patients with AMI in Zhengzhou central hospital from May 2020 to August 2022 were selected, all of whom underwent PCI. The level of serum NT-proBNP before and after PCI was detected. The level of serum NT-probNP after PCI was ≥125 pg/mL, and the level of serum NT-probNP after PCI was normal. Univariate analysis of the general data of the elevated NT-proBNP group and the normal group, Lasso regression model was used to screen the screening variables, and Logistic regression was used to analyze the influencing factors of serum NT-proBNP level in elderly AMI patients after PCI. The prognosis recovery of patients with different NT-proBNP and the level of NT-proBNP in patients with different prognosis were compared and analyzed. ROC curve was drawn to analyze the predictive value of NT-proBNP level in patients with short-term prognosis after PCI. Results Logistic regression analysis showed that the time from onset to PCI, age, left ventricular ejection fraction (LVEF), stroke, number of stents implanted, no recirculation and stent diameter were the influencing factors of serum NT-proBNP level in elderly AMI patients after PCI. The incidence of adverse cardiovascular events (MACE) was 21.43% (21/98) in 98 patients followed up 6 months after surgery, and the incidence of NT-proBNP increased group was 68.00% (17/25), which was significantly higher than that of normal group (5.48% (4/73) (P<0.05). The level of NT-proBNP in the group with MACE was significantly higher than that in the group without MACE (P<0.05). ROC curve showed that AUC was 0.813 (95%CI 0.721 to0.884), sensitivity and specificity were 80.95% and 79.22%, respectively, suggesting that serum NT-proBNP level after PCI had certain predictive value for short-term prognosis of patients. Conclusion Serum NT-proBNP level in elderly AMI patients after PCI has a good ability to predict the short-term prognosis of patients. Comprehensive consideration of the number of stents inserted, the presence of stroke, the presence of reflow and age and other factors to strengthen the monitoring of NT-proBNP level is helpful to prevent and control the occurrence of MACE, so as to improve the prognosis of patients.

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2.	Guo L, Lv HC, Huang RC. Percutaneous coronary intervention in elderly patients with coronary chronic total occlusions: current evidence and future perspectives. Clin Interv Aging, 2020, 15: 771-781.
3.	高燕, 高吊清, 赵洋洋, 等. 血清APN和NT-proBNP在川崎病患儿冠状动脉病变早期诊断中的意义. 中西医结合心脑血管病杂志, 2021, 19(6): 1048-1050.
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5.	Edwards KD, Tighe MP. How to use N-terminal pro-brain natriuretic peptide (NT-proBNP) in assessing disease severity in bronchiolitis. Arch Dis Child Educ Pract Ed, 2020, 105(5): 282-288.
6.	Jimenez-Zepeda VH, Lee H, Tay J, et al. N-terminal pro-brain natriuretic peptide (NTproBNP) in patients with symptomatic multiple myeloma: report from a single institution. Ann Hematol, 2021, 100(10): 2521-2527.
7.	Duceppe E, Patel A, Chan MTV, et al. Preoperative N-terminal pro-b-type natriuretic peptide and cardiovascular events after noncardiac surgery: a cohort study. Ann Intern Med, 2020, 172(2): 96-104.
8.	Pavanello S, Campisi M, Fabozzo A, et al. The biological age of the heart is consistently younger than chronological age. Sci Rep, 2020, 10(1): 10752.
9.	Colom G, Salvador JP, Acosta G, et al. Competitive ELISA for N-terminal pro-brain natriuretic peptide (NT-proBNP) determination in human plasma. Analyst, 2020, 145(20): 6719-6727.
10.	Koepp KE, Obokata M, Reddy YNV, et al. Hemodynamic and functional impact of epicardial adipose tissue in heart failure with preserved ejection fraction. JACC Heart Fail, 2020, 8(8): 657-666.
11.	Cao Z, Jia Y, Zhu B. BNP and NT-proBNP as diagnostic biomarkers for cardiac dysfunction in both clinical and forensic medicine. Int J Mol Sci, 2019, 20(8): 1820.
12.	Cunningham JW, Vaduganathan M, Claggett BL, et al. Effects of sacubitril/valsartan on N-terminal pro-b-type natriuretic peptide in heart failure with preserved ejection fraction. JACC Heart Fail, 2020, 8(5): 372-381.
13.	Yamaoka M, Yoshida M, Nakashima A, et al. N-terminal pro-brain natriuretic peptide predicts hospitalization for ischemic stroke in Japanese hemodialysis patients. Clin Exp Nephrol, 2022, 26(11): 1111-1118.
14.	Yunfei L, Qiang F, Yue W, et al. N-terminal pro-brain natriuretic peptide levels in patients with anomalous left coronary artery from pulmonary artery. J Cardiothorac Surg, 2020, 15(1): 15.
15.	王洪恩, 郭宁, 张胜高, 等. 冠心病患者PCI术后1年内MACE风险与NT-proBNP, hs-CRP, Hcy的关系. 中华保健医学杂志, 2022, 24(6): 457-460.

1. Damluji AA, van Diepen S, Katz JN, et al. Mechanical complications of acute myocardial infarction: a scientific statement from the American Heart Association. Circulation, 2021, 144(2): 16-35.
2. Guo L, Lv HC, Huang RC. Percutaneous coronary intervention in elderly patients with coronary chronic total occlusions: current evidence and future perspectives. Clin Interv Aging, 2020, 15: 771-781.
3. 高燕, 高吊清, 赵洋洋, 等. 血清APN和NT-proBNP在川崎病患儿冠状动脉病变早期诊断中的意义. 中西医结合心脑血管病杂志, 2021, 19(6): 1048-1050.
4. 中华医学会心血管病学分会, 中华心血管病杂志编辑委员会, 《中国循环杂志》编辑委员会. 急性心肌梗死诊断和治疗指南. 中华心血管病杂志, 2001, 29(12): 710-725.
5. Edwards KD, Tighe MP. How to use N-terminal pro-brain natriuretic peptide (NT-proBNP) in assessing disease severity in bronchiolitis. Arch Dis Child Educ Pract Ed, 2020, 105(5): 282-288.
6. Jimenez-Zepeda VH, Lee H, Tay J, et al. N-terminal pro-brain natriuretic peptide (NTproBNP) in patients with symptomatic multiple myeloma: report from a single institution. Ann Hematol, 2021, 100(10): 2521-2527.
7. Duceppe E, Patel A, Chan MTV, et al. Preoperative N-terminal pro-b-type natriuretic peptide and cardiovascular events after noncardiac surgery: a cohort study. Ann Intern Med, 2020, 172(2): 96-104.
8. Pavanello S, Campisi M, Fabozzo A, et al. The biological age of the heart is consistently younger than chronological age. Sci Rep, 2020, 10(1): 10752.
9. Colom G, Salvador JP, Acosta G, et al. Competitive ELISA for N-terminal pro-brain natriuretic peptide (NT-proBNP) determination in human plasma. Analyst, 2020, 145(20): 6719-6727.
10. Koepp KE, Obokata M, Reddy YNV, et al. Hemodynamic and functional impact of epicardial adipose tissue in heart failure with preserved ejection fraction. JACC Heart Fail, 2020, 8(8): 657-666.
11. Cao Z, Jia Y, Zhu B. BNP and NT-proBNP as diagnostic biomarkers for cardiac dysfunction in both clinical and forensic medicine. Int J Mol Sci, 2019, 20(8): 1820.
12. Cunningham JW, Vaduganathan M, Claggett BL, et al. Effects of sacubitril/valsartan on N-terminal pro-b-type natriuretic peptide in heart failure with preserved ejection fraction. JACC Heart Fail, 2020, 8(5): 372-381.
13. Yamaoka M, Yoshida M, Nakashima A, et al. N-terminal pro-brain natriuretic peptide predicts hospitalization for ischemic stroke in Japanese hemodialysis patients. Clin Exp Nephrol, 2022, 26(11): 1111-1118.
14. Yunfei L, Qiang F, Yue W, et al. N-terminal pro-brain natriuretic peptide levels in patients with anomalous left coronary artery from pulmonary artery. J Cardiothorac Surg, 2020, 15(1): 15.
15. 王洪恩, 郭宁, 张胜高, 等. 冠心病患者PCI术后1年内MACE风险与NT-proBNP, hs-CRP, Hcy的关系. 中华保健医学杂志, 2022, 24(6): 457-460.

Chinese Journal of Evidence-Based Medicine

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