Baseline NT-proBNP and biomarkers of inflammation and necrosis in patients with ST-segment elevation myocardial infarction: Insights from the APEX-AMI trial

Sean Van Diepen, Matthew T. Roe, Renato D. Lopes, Amanda Stebbins, Stefan James, L. Kristin Newby, David J. Moliterno, Franz Josef Neumann, Justin A. Ezekowitz, Kenneth W. Mahaffey, Judith S. Hochman, Christian W. Hamm, Paul W. Armstrong, Pierre Theroux, Christopher B. Granger

Research output: Contribution to journalArticlepeer-review

23 Scopus citations

Abstract

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.

Original languageEnglish
Pages (from-to)106-113
Number of pages8
JournalJournal of Thrombosis and Thrombolysis
Volume34
Issue number1
DOIs
StatePublished - Jul 2012

Bibliographical note

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.

Keywords

  • C-reactive protein
  • Interleukin-10
  • Interleukin-6
  • N-terminal pro-brain natriuretic peptide

ASJC Scopus subject areas

  • Hematology
  • Cardiology and Cardiovascular Medicine

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