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B-type natriuretic peptide as a predictor of anterior wall location in patients with non-ST-elevation myocardial
Rogério Bicudo Ramos1, Célia M Strunz, Solange Desirée Avakian
1Heart Institute, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
Insights
B-type natriuretic peptide levels are key predictors of anterior wall myocardial infarction in non-ST-elevation myocardial infarction patients. Higher peptide levels also indicate increased risk for cardiac events during hospitalization and follow-up.
Area of Science:
- Cardiology
- Biomarkers in Cardiovascular Disease
- Myocardial Infarction Research
Background:
- Anterior wall involvement in ST-elevation myocardial infarction is linked to poorer prognosis.
- Noninvasive methods for identifying ischemic territories in non-ST-elevation myocardial infarction are limited.
Purpose of the Study:
- To identify predictive factors for anterior myocardial territory location in non-ST-elevation myocardial infarction.
- To investigate the association between B-type natriuretic peptide and anterior wall infarcts.
Main Methods:
- Analysis of clinical, echocardiographic, and laboratory data from 170 non-ST-elevation myocardial infarction patients.
- Measurement of B-type natriuretic peptide within 24 hours of hospitalization.
- Coronary angiographic assessment of infarct territory.
Main Results:
- B-type natriuretic peptide was the sole independent predictor of anterior wall infarct in non-ST-elevation myocardial infarction (OR = 3.70).
- Elevated B-type natriuretic peptide predicted in-hospital cardiac events (OR = 5.05) and follow-up cardiac events (HR = 1.79).
- 47% of patients had anterior wall involvement, while 53% had inferior and lateral involvement.
Conclusions:
- B-type natriuretic peptide is the only independent factor associated with anterior wall involvement in non-ST-elevation myocardial infarction.
- Admission B-type natriuretic peptide levels predict both in-hospital and subsequent cardiac events.
Objective:
Involvement of the left ventricular anterior wall in ST-elevation myocardial infarction has a worse prognosis compared with other regions. In non-ST-elevation myocardial infarction, noninvasive methods of locating the ischemic myocardial territory have been limited. The objective of this report is therefore to determine what factors are predictive of the anterior location of the ischemic myocardial territory.
Methods:
This study included 170 patients with non-ST-elevation myocardial infarction. Clinical, echocardiographic, and laboratory characteristics, including B-type natriuretic peptide measured within 24 hours of hospitalization, and coronary angiographic features were analyzed.
Results:
The mean age was 64.5 ± 12.3 years, and 112 of the patients were male (66%). The median follow-up was 23 months. The territory involved, as determined from the angiogram, was divided into anterior [n = 80 (47%)] regions and inferior and lateral [n = 90 (53%)] regions. Multivariate analysis showed that B-type natriuretic peptide was the only independent predictor of an anterior wall infarct [OR = 3.70 (95% CI: 1.61 - 8.53); P = 0.002] in non-STelevation myocardial infarction patients. Multivariate analysis also showed that B-type natriuretic peptide was an independent predictor of in-hospital cardiac events during index admission [OR = 5.05 (95% CI: 1.49 - 17.12); P = 0.009] and of cardiac events occurring during follow-up [HR = 1.79 (95% CI: 1.05 - 3.04); P = 0.032].
Conclusions:
B-type natriuretic peptide was the only factor independently associated with anterior wall involvement in non-ST-elevation myocardial infarction, and the peptide levels upon admission predicted in-hospital and subsequent cardiac events.
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