CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 5, June 2013
AFRICA
165
The optimal time of B-type natriuretic peptide sampling
associated with post-myocardial infarction remodelling
after primary percutaneous coronary intervention
HYUNMIN CHOI, BYUNG-SU YOO, JOON-HYUNG DOH, HEE-JEONG YOON, MIN-SOO AHN,
JANG-YOUNG KIM, SEUNG-HWAN LEE, JUNGHAN YOON
Abstract
Aims:
To find the optimal time to evaluate plasma B-type
natriuretic peptide (BNP), which is related to post-myocard-
ial infarction remodelling (PMIR), we measured serial plas-
ma BNP levels according to time protocols after primary
percutaneous coronary intervention (PCI).
Background:
It has been established that plasma BNP levels
can predict the development of PMIR in patients with
ST-elevation myocardial infarction (STEMI). However, the
time of plasma BNP sampling associated with PMIR is still
controversial.
Methods:
We analysed 42 patients who were diagnosed as
PMIR on six-month follow-up echocardiography among
131 patients with STEMI. We then compared clinical vari-
ables including plasma BNP between the remodelling group
and the non-remodelling group. The plasma BNP level was
obtained on hospital admission (acute phase), at two to five
days (early phase), three to four weeks (late phase) and at the
six-month follow up (long term).
Results:
Early-phase and long-term BNP levels were higher
in the remodelling group. The serial plasma BNP levels,
according to study protocols, showed a biphasic pattern of
elevation. In multiple logistic regression analyses, early-phase
BNP [odds ratio (OR): 1.013,
p
<
0.01] and acute-phase BNP
levels (OR: 1.007,
p
=
0.02) were independent predictors of
PMIR. However, early-phase BNP level was statistically a
more powerful predictor of PMIR during follow up.
Conclusion:
Consecutive BNP levels after primary PCI
showed a biphasic peak elevation during follow up. Early-
phase plasma BNP level was an independent predictor of
PMIR in patients with STEMI.
Keywords:
B-type natriuretic peptide, remodelling, myocardial
infarction
Submitted 17/8/12, accepted 17/4/13
Cardiovasc J Afr
2013;
24
: 165–170
DOI: 10.5830/CVJA-2013-024
Post-myocardial infarction remodelling (PMIR) in patients with
ST-elevation myocardial infarction (STEMI) is detrimental to
normal left ventricular (LV) systolic function and is associated
with heart failure and death due to cardiovascular events.
1
Although an early reperfusion strategy such as primary
percutaneous coronary intervention (PCI) has becomewidespread
in recent years, a significant percentage of STEMI patients still
suffer from PMIR.
Anterior wall infarction, peak levels of creatine kinase
myocardial band (CK-MB) and troponin I, LV systolic
dysfunction, and wall motion score index (WMSI) have been
associated with the development of PMIR.
2
Also, increased
expression of B-type natriuretic peptide (BNP) has been
suggested to be an indicator of PMIR, so plasma BNP levels can
be used as diagnostic and monitoring tools for PMIR in patients
with STEMI.
3,4
Plasma BNP levels in patients with STEMI have shown a
positive correlation with the degree of LV systolic and diastolic
dysfunction.
5
Although the prognostic significance of BNP levels
has been elucidated, a suitable point in time for BNP sampling
related to PMIR has not been established. Several studies have
reported that plasma BNP levels measured at hospital admission
or in the acute phase were meaningful predictors of PMIR,
5,6
whereas others have stated that later sampling during follow up
was associated with PMIR.
7,8
We evaluated serial changes in plasma BNP levels after
successful revascularisation using primary PCI. We identified
a suitable point in time for BNP sampling as an independent
predictor of PMIR in patients with STEMI.
Methods
The research protocol was approved by the Committee on Ethics
and Research of Wonju Christian Hospital (Wonju College of
Medicine, Yonsei University, Wonju, Republic of Korea). Written
informed consent was obtained from each patient.
Top Care Cardiovascular Centre, Gumdan Top Hospital,
Dangha-dong, Seo-gu, Incheon, South Korea
HYUNMIN CHOI, MD,
HEE-JEONG YOON, MD
Division of Cardiology, Ilsan Paik Hospital, Inje University
College of Medicine, Goyang, Republic of Korea
JOON-HYUNG DOH, MD
Division of Cardiology, Wonju Christian Hospital, Wonju
College of Medicine, Yonsei University, Wonju, Republic of
Korea
BYUNG-SU YOO, MD
MIN-SOO AHN, MD
JANG-YOUNG KIM, MD
SEUNG-HWAN LEE, MD
JUNGHAN YOON, MD
Institute of Lifelong Health, Wonju Christian Hospital, Wonju
College of Medicine, Yonsei University, Wonju, Republic of
Korea
BYUNG-SU YOO, MD
MIN-SOO AHN, MD
JANG-YOUNG KIM, MD
SEUNG-HWAN LEE, MD
JUNGHAN YOON, MD
