Superiornost NT pro mozdanog natriuretskog peptida u prognozi velikih nezeljenih kardiovaskularnih dogadjaja u pacijenata sa akutnim infarktom miokarda bez srcane dekompenzacije

Superiornost NT-proBNP ya prognozu MACE u pacijenata sa AIM bez srcane dekompenzacije

  • Rada M Vucic Katedra za Internu medicinu, Fakultet medicinskih nauka, Univerzitet u Kragujevcu, Svetozara Markovica 69, 34000 Kragujevac, Srbija
  • Vladimir Ignjatovic Katedra za Internu medicinu, Fakultet medicinskih nauka, Univerzitet u Kragujevcu, Svetozara Markovica 69, 34000 Kragujevac, Srbija
  • Olivera Andrejic Klinika za plucne bolesti, Univerziteteski Klinicki Centar Kragujevac, Srbija
  • Katarina Cupic Klinika za oftalmologiju, Univerzitetski Klinicki Centar Kragujevac, Zmaj Jovina 30, 34000 Kragujevac, Srbija
  • Miodrag Sreckovic Katedra za Internu medicinu, Fakultet medicinskih nauka, Univerzitet u Kragujevcu, Svetozara Markovica 69, 34000 Kragujevac, Srbija
  • Jelena Vuckovic Filipovic Katedra za Internu medicinu, Fakultet medicinskih nauka, Univerzitet u Kragujevcu, Svetozara Markovica 69, 34000 Kragujevac, Srbija
  • Marija Sekulic Katedra za Higijenu i Ekologiju, Fakultet medicinskih nauka, Univerzitet u Kragujevcu, Svetozara Markovica 69, 34000 Kragujevac, Srbija
  • Milan Dobric Medicinski Fakultet, Univerzitet u Beogradu, 11000 Beograd, Srbija
  • Jelena Rakocevic Institut za Histologiju i Embriologiju “Aleksandar Đ. Kostić”, Medicinski Fakultet, Univerzitet u Beogradu, 11000 Beograd, Srbija
DOI: https://doi.org/10.5937/afmnai42-53487
Ključne reči: prognoza, akutni infarkt miokarda, NT-proBNP

Sažetak


UVOD: Prognosticki znacaj mnogih markera se ispituje kod pacijenata sa akutnim infarktom miokarda (AIM). Istrazivaci se fokusiraju na one koji su siroko dostupni, imaju visoku senzitivnost i specificnost.       

CILJ: Cilj naseg istrazivanja je bio da se ispita prognosticki znacaj NT pro mozdanog peptida (NT-proBNP) i njegova superiornost u odnosu na ostale markere koji se koriste kod pacijenata sa AIM.  

PACIJENTI I METOD RADA: Studija je ukljucila 66 pacijenata sa AIM. Evaluirane varijable: simptomi, kardiovaskularni faktori rizika, labaratorijske analize (ukljucujuci NT-proBNP), elektrokardiografija, ejekciona frakcija leve komore (LVEF) i koronarna angiografija. Jednomesecni i sestomesecni veliki nezeljeni kardiovaskularni dogadjaji (MACE) su ukljucivali: ponovljeni AIM, poremecaji srcanog ritma, akutna srcana insuficijencija, mozdani udar, smrtni ishod.

REZULTATI: Pacijenti sa jednomesecnim i sestomesecnim MACE su bili starije zivotne dobi, imali su infarkte prednjeg zida, povisene NT-proBNP, ureu, kreatinin, nizu LVEF, CCr i hemoglobin. NT-proBNP je bio nezavistan prediktor kratkorocnog (p=0,002) i dugorocnog (p=0,000) MACE. Vrednost NT-proBNP na prijemu 1467 pg/ml se pokazala kao nezavistan prediktor jednomesecnog MACE, a vrednost 996 pg/ml kao nezavistan prediktor sestomesecnog MACE.

ZAKLJUCAK: NT-proBNP je snazan prediktor MACE kratkorocno i dugorocno kod pacijenata sa AIM bez srcane dekompenzacije. 

Reference

1. Felker GM, Shaw LK, O’Connor CM. A standardized definition of ischemic cardiomyopathy for use in clinical research. J Am Coll Cardiol 2002;39:210–8.
https://doi: 10.1016/s0735-1097(01)01738-7.
2. Vucic RM, Andrejic OM, Stokanovic D, et al. Galectin-3 as a Prognostic Biomarker in Patients with First Acute Myocardial Infarction without Heart Failure. Diagnostics 2023; 13(21):3348. https://doi.org/10.3390/diagnostics13213348.
3. Thygesen K, Alpert JS, Jaffe AS, ESC Scientific Document Group, Fourth universal definition of myocardial infarction. EHJ 2019; 40 (3):237–269. https://doi.org/10.1093/eurheartj/ehy462.
4. Omland T. Clinical and laboratory diagnostics of cardiovascular disease: focus on natriuretic peptides and cardiac ischemia. Scand J Clin Lab Invest 2005;65 (suppl 240):18-24.
https://doi: 10.1080/00365510500236077.
5. Heeschen C, Hamm CW, Mitrovic V, et al. Platelet Receptor Inhibition in Ischemic Syndrome Management (PRISM) Investigators. N-terminal pro-B-type natriuretic peptide levels for dynamic risk stratification of patients with acute coronary syndromes. Circulation 2004 Nov 16;110(20):3206-12.
https://doi: 10.1161/01.CIR.0000147611.92021.2B.
6. O'Donoghue ML, Morrow DA, Cannon CP, et al. Multimarker Risk Stratification in Patients With Acute Myocardial Infarction. J Am Heart Assoc 2016 May 20;5(5):e002586.
https://doi: 10.1161/JAHA.115.002586.
7. Cai A, Dillon C, Hillegass WB, et al. Risk of major adverse cardiovascular events and major hemorrhage among white and Black patients undergoing percutaneous coronary intervention. J Am Heart Assoc 2019;8(22):e012874.
https://doi: 10.1161/JAHA.119.012874.
8. Tsai I-T, Wang C-P, Lu Y-C, et al. The burden of major adverse cardiac events in patients with coronary artery disease. BMC Cardiovasc Disord 2017;17(1):1–13.
https://doi: 10.1016/j.jval.2014.03.622.
9. Wang Y, Zhou J, Zhou P, et al. Prognostic significance of serial N-terminal pro-B-type natriuretic peptide levels in patients with acute myocardial infarction: A prospective study. Am Heart J 2023 Aug;262:90-99. https://doi: 10.1016/j.ahj.2023.04.015.
10. Nasution SA, Perkasa H, Ginanjar E, Rinaldi I. In-Hospital Major Adverse Cardiac Events Factor Predictors on ST-Elevation Myocardial Infarction after Primary Percutaneous Coronary Intervention at dr. Cipto Mangunkusumo General Hospital. eJKI. 2022;10(2):107-113. https://doi.org/10.23886/ejki.10.193.107-13.
11. Wang J, Gao W, Chen G, et al; BIPass investigators. Biomarker-based risk model to predict cardiovascular events in patients with acute coronary syndromes - Results from BIPass registry. Lancet Reg Health West Pac. 2022 May 30;25:100479.
https://doi: 10.1016/j.lanwpc.2022.100479.
12. Jeong JH, Lee KS, Park SM, et al. Prediction of longitudinal clinical outcomes after acute myocardial infarction using a dynamic machine learning algorithm. Front Cardiovasc Med. 2024 Apr 5;11:1340022. https://doi: 10.3389/fcvm.2024.1340022.
13. Li N, Chen R, Li J, et al. Prognostic significance of serial N-terminal pro-B-type natriuretic peptide levels in patients with acute myocardial infarction: A prospective study. Am Heart J. 2023 Aug;262:90-99.
https://doi: 10.1016/j.ahj.2023.04.015.
14. Velders MA, Wallentin L, Becker RC, et al. Biomarkers for risk stratification of patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention: Insights from the Platelet Inhibition and Patient Outcomes trial. American Heart Journal, 2015;169 (6):879-889.e7.
https://doi.org/10.1016/j.ahj.2015.02.019.
15. Jering KS, Claggett BL, Pfeffer MA, et al. Prognostic Importance of NT-ProBNP (N-Terminal Pro-B-Type Natriuretic Peptide) Following High-Risk Myocardial Infarction in the PARADISE-MI Trial. Circ. Heart Fail. 2023, 16, e010259.
https://doi: 10.1161/CIRCHEARTFAILURE.122.010259.
16. Shen S, Ye J, Wu X, Li X. Association of N-terminal pro-brain natriuretic peptide level with adverse outcomes in patients with acute myocardial infarction: A meta-analysis. Heart Lung. 2021 Nov-Dec;50(6):863-869. https://doi: 10.1016/j.hrtlng.2021.07.007.
https://doi: 10.1016/j.hrtlng.2021.07.007.
17. Sykes R, Doherty D, Morrow A, Mangion K, Rushd A, Berry C. NT-proBNP in patients presenting with myocardial infarction and non-obstructive coronary arteries without left ventricular systolic dysfunction. Am Heart J Plus. 2023 Jul 27;33:100311.
https://doi: 10.1016/j.ahjo.2023.100311.
18. Jernberg T, Stridsberg M, Venge P, Lindahl B. N-terminal pro brain natriuretic peptide on admission for early risk stratification of patients with chest pain and no ST-segment elevation. J Am Coll Cardiol. 2002; 40: 437-445.
https:// doi: 10.1016/s0735-1097(02)01986-1.
19. James SK, Lindahl B, Siegbahn A, Stridsberg M, Venge P, Armstrong P. N-terminal pro-brain natriuretic peptide and other risk markers for the separate prediction of mortality and subsequent myocardial infarction in patients with unstable coronary artery disease: a Global Utilization of Strategies To Open occluded arteries (GUSTO)-IV substudy. Circulation. 2003; 108: 275-281.
https:// doi: 10.1161/01.CIR.0000079170.10579.DC.
20. Jernberg T, Lindahl B, Siegbahn A, Andren B, Frostfeldt G, Lagerqvist B. N-terminal pro brain natriuretic peptide in relation to inflammation, myocardial necrosis and the effect of an invasive strategy in unstable coronary artery disease. J Am Coll Cardiol. 2003;42:1909-1916.
https:// doi: 10.1016/j.jacc.2003.07.015.
Objavljeno
2025/11/19
Broj časopisa
Vol. 42 Br. 2 (2025): Acta facultatis medicae Naissensis
Rubrika
Originalni rad / Original article