Please use this identifier to cite or link to this item: http://hdl.handle.net/1942/11221
Title: Prediction of cardiogenic shock using plasma B-type natriuretic peptide and the N-terminal fragment of its pro-hormone concentrations in ST elevation myocardial infarction: An analysis from the ASSENT-4 Percutaneous Coronary Intervention Trial
Authors: Jarai, Rudolf
Huber, Kurt
BOGAERTS, Kris 
Sinnaeve, Peter R.
Ezekowitz, Justin
Ross, Allan M.
Zeymer, Uwe
Armstrong, Paul W.
Van de Werf, Frans J.
Issue Date: 2010
Publisher: LIPPINCOTT WILLIAMS & WILKINS
Source: CRITICAL CARE MEDICINE, 38 (9). p. 1793-1801
Abstract: Objective: Cardiogenic shock is a major cause of death in ST elevation myocardial infarction. We investigated whether determination of B-type natriuretic peptide and the N-terminal fragment of its pro-hormone in the acute phase of ST elevation myocardial infarction could identify patients prone to development of cardiogenic shock. Design: Retrospective analysis of a multicenter, randomized open-label trial (ASSENT-4 PCI; ClinicalTrials.gov Identifier: NCT00168792). Methods: Plasma B-type natriuretic peptide and the N-terminal fragment of its pro-hormone were determined in available stored samples of 1016 ST elevation myocardial infarction patients without signs of cardiogenic shock at randomization to primary percutaneous coronary intervention or to full-dose tenecteplase before percutaneous coronary intervention. The end point of the present analysis was in-hospital cardiogenic shock. Interventions: None. Measurements and Main Results: In total, 57 (5.6%) patients had cardiogenic shock during index hospitalization. In-hospital cardiogenic shock increased precipitously with higher baseline concentrations of plasma B-type natriuretic peptide and the N-terminal fragment of its pro-hormone (B-type natriuretic peptide and the N-terminal fragment of its pro-hormone <= 67 pg/mL: 1.9%; 68-1482 pg/mL: 5.9%; > 1482 pg/mL: 14.9%; p < .001). Higher B-type natriuretic peptide and the N-terminal fragment of its pro-hormone concentrations were predictors of in-hospital shock, especially among those patients with relatively low clinical risk (no requirement of inotropic support before angiography, systolic blood pressure > 100 mm Hg, heart rate < 100 bpm, Global Utilization of Streptikonase and Tissue-Plasminogen Activator for Occluded Coronary Arteries score of < 122). In multivariate Cox regression analysis, higher plasma B-type natriuretic peptide and the N-terminal fragment of its pro-hormone concentrations remained significant predictors of shock, in addition to age, systolic blood pressure, heart rate, and randomization to facilitated percutaneous coronary intervention and Killip classification. Furthermore, plasma B-type natriuretic peptide and the N-terminal fragment of its pro-hormone significantly predicted in-hospital shock independently of the validated Global Utilization of Streptikonase and Tissue-Plasminogen Activator for Occluded Coronary Arteries score (p = .014). Conclusion: Plasma B-type natriuretic peptide and the N-terminal fragment of its pro-hormone concentrations measured early in the acute phase of ST elevation myocardial infarction are useful in predicting the development of in-hospital cardiogenic shock. (Crit Care Med 2010; 38:1793-1801)
Notes: [Jarai, Rudolf; Huber, Kurt] Wilhelminen Hosp, Dept Med Cardiol & Emergency Med 3, Vienna, Austria. [Bogaerts, Kris] Katholieke Univ Leuven, Interuniv Inst Biostat & Stat Biostat I Biostat, Louvain, Belgium. [Bogaerts, Kris] Univ Hasselt, Hasselt, Belgium. [Sinnaeve, Peter R.] Univ Hosp, Dept Cardiol, Louvain, Belgium. [Ezekowitz, Justin] Univ Alberta Hosp, Mazankowski Alberta Heart Inst, Edmonton, AB T6G 2B7, Canada. [Ross, Allan M.] Duke Clin Res Unit, Div Cardiol, Durham, NC USA. [Zeymer, Uwe] Herzzentrum Ludwigshafen, Med Klin B, Ludwigshafen, Germany. [Armstrong, Paul W.] Univ Alberta, Edmonton, AB, Canada. kurt.huber@wienkav.at
Keywords: cardiogenic shock; B-type natriuretic peptide; ST-elevation myocardial infarction;cardiogenic shock; B-type natriuretic peptide; ST-elevation myocardial infarction
Document URI: http://hdl.handle.net/1942/11221
ISSN: 0090-3493
e-ISSN: 1530-0293
DOI: 10.1097/CCM.0b013e3181eaaf2a
ISI #: 000281559500004
Category: A1
Type: Journal Contribution
Validations: ecoom 2011
Appears in Collections:Research publications

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