TY - JOUR
T1 - Baseline NT-proBNP and biomarkers of inflammation and necrosis in patients with ST-segment elevation myocardial infarction
T2 - Insights from the APEX-AMI trial
AU - Van Diepen, Sean
AU - Roe, Matthew T.
AU - Lopes, Renato D.
AU - Stebbins, Amanda
AU - James, Stefan
AU - Newby, L. Kristin
AU - Moliterno, David J.
AU - Neumann, Franz Josef
AU - Ezekowitz, Justin A.
AU - Mahaffey, Kenneth W.
AU - Hochman, Judith S.
AU - Hamm, Christian W.
AU - Armstrong, Paul W.
AU - Theroux, Pierre
AU - Granger, Christopher B.
N1 - Funding Information:
Acknowledgments The APEX-AMI trial from which this work was derived, was supported by a research grant jointly funded from Procter & Gamble and Alexion Pharmaceuticals.
PY - 2012/7
Y1 - 2012/7
N2 - Coronary plaque rupture is associated with a systemic inflammatory response. The relationship between baseline N-terminal pro B-type natriuretic peptide (NT-proBNP), a prognostic marker in patients with acute coronary syndromes, and systemic inflammatory mediators in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI) is not well described. Of 5,745 STEMI patients treated with primary PCI in the APEX-AMI trial, we evaluated the relationship between baseline NT-proBNP levels and baseline levels of inflammatory markers and markers of myonecrosis in a subset of 772 who were enrolled in a biomarker substudy. Spearman correlations (r s) were calculated between baseline NT-proBNP levels and a panel of ten systemic inflammatory biomarkers. Interleukin (IL)-6, a pro-inflammatory cytokine, was significantly positively correlated with NT-proBNP (r s = 0.317, P < 0.001). In a sensitivity analysis excluding all heart failure patients, the correlation between baseline IL-6 and NT-proBNP remained significant (n = 651, r s = 0.296, P < 0.001). A positive association was also observed with high sensitivity C-reactive protein (r s = 0.377, P < 0.001) and there was a weak negative correlation with the anti-inflammatory cytokine IL-10 (r s = -0.109, P = 0.003). No other significant correlations were observed among the other testes inflammatory cytokines and chemokines. In STEMI patients undergoing primary PCI, the pro-inflammatory cytokine IL-6 was modestly correlated with baseline NT-proBNP levels. This relationship remained significant in patients without heart failure. This finding is consistent with pre-clinical and clinical research suggesting that systemic inflammation may influence NT-proBNP expression independently of myocardial stretch.
AB - Coronary plaque rupture is associated with a systemic inflammatory response. The relationship between baseline N-terminal pro B-type natriuretic peptide (NT-proBNP), a prognostic marker in patients with acute coronary syndromes, and systemic inflammatory mediators in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI) is not well described. Of 5,745 STEMI patients treated with primary PCI in the APEX-AMI trial, we evaluated the relationship between baseline NT-proBNP levels and baseline levels of inflammatory markers and markers of myonecrosis in a subset of 772 who were enrolled in a biomarker substudy. Spearman correlations (r s) were calculated between baseline NT-proBNP levels and a panel of ten systemic inflammatory biomarkers. Interleukin (IL)-6, a pro-inflammatory cytokine, was significantly positively correlated with NT-proBNP (r s = 0.317, P < 0.001). In a sensitivity analysis excluding all heart failure patients, the correlation between baseline IL-6 and NT-proBNP remained significant (n = 651, r s = 0.296, P < 0.001). A positive association was also observed with high sensitivity C-reactive protein (r s = 0.377, P < 0.001) and there was a weak negative correlation with the anti-inflammatory cytokine IL-10 (r s = -0.109, P = 0.003). No other significant correlations were observed among the other testes inflammatory cytokines and chemokines. In STEMI patients undergoing primary PCI, the pro-inflammatory cytokine IL-6 was modestly correlated with baseline NT-proBNP levels. This relationship remained significant in patients without heart failure. This finding is consistent with pre-clinical and clinical research suggesting that systemic inflammation may influence NT-proBNP expression independently of myocardial stretch.
KW - C-reactive protein
KW - Interleukin-10
KW - Interleukin-6
KW - N-terminal pro-brain natriuretic peptide
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U2 - 10.1007/s11239-012-0691-0
DO - 10.1007/s11239-012-0691-0
M3 - Article
C2 - 22307842
AN - SCOPUS:84862755099
SN - 0929-5305
VL - 34
SP - 106
EP - 113
JO - Journal of Thrombosis and Thrombolysis
JF - Journal of Thrombosis and Thrombolysis
IS - 1
ER -