Prehospital electrocardiographic acuteness score of ischemia is inversely associated with neurohormonal activation in STEMI patients with severe ischemia

Yama Fakhri*, Mikkel Malby Schoos, Maria Sejersten, Mads Ersbøll, Nana Valeur, Lars Køber, Christian Hassager, Galen S. Wagner, Jens Kastrup, Peter Clemmensen

*Corresponding author af dette arbejde

Publikation: Bidrag til tidsskriftArtikelForskningpeer review

Abstract

Background Elevated levels of N-terminal pro brain natriuretic peptide (NT-proBNP) are associated with adverse cardiovascular outcome after ST elevation myocardial infarction (STEMI). We hypothesized that decreasing acuteness-score (based on the electrocardiographic score by Anderson-Wilkins acuteness score of myocardial ischemia) is associated with increasing NT-proBNP levels and the impact of decreasing acuteness-score on NT-proBNP levels is substantial in STEMI patients with severe ischemia. Methods In 186 STEMI patients treated with primary percutaneous coronary intervention (pPCI), the severity of ischemia (according to Sclarovsky-Birnbaum severity grades of ischemia) and the acuteness-score were obtained from prehospital ECG. Patients were classified according to the presence of severe ischemia or non-severe ischemia and acute ischemia or non-acute ischemia. Plasma NT-proBNP (pmol/L) was obtained after pPCI within 24 hours of admission and was correlated with the acuteness-score. Results NT-proBNP levels were median (25th–75th interquartile) 112 (51–219) pmol/L in patients with non-severe ischemia (71.5%) and 145 (79–339) in patients with severe ischemia (28.5%) (p = 0.074). NT-proBNP levels were highest in patients with severe and non-acute ischemia compared to those with severe and acute ischemia (182 (98–339) pmol/L vs 105 (28–324) pmol/L, p = 0.012). There was a negative correlation between acuteness-score and log(NT-proBNP) in patients with severe ischemia (r = 0.395, p = 0.003), which remained significant in multilinear regression analysis (β = −0.155, p = 0.007). No correlation was observed between the acuteness-score and log(NT-proBNP) in patients with non-severe ischemia (p = 0.529) or in the entire population (p = 0.187). Conclusion In STEMI patients with severe ischemia, neurohormonal activation is inversely associated with ECG patterns of acute myocardial ischemia.

OriginalsprogEngelsk
Sider (fra-til)90-96
Antal sider7
TidsskriftJournal of Electrocardiology
Vol/bind50
Udgave nummer1
DOI
StatusUdgivet - 1 jan. 2017

Fingeraftryk

Udforsk hvilke forskningsemner 'Prehospital electrocardiographic acuteness score of ischemia is inversely associated with neurohormonal activation in STEMI patients with severe ischemia' indeholder.

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