• Erkan Ayhan, Turgay Isık, Huseyin Uyarel, Mehmet Ergelen, Gokhan Cicek, Ferhat Ozyurtlu, Bahman Ghannadian, and Ibrahim Halil Tanboga.
• Balikesir University, School of Medicine, Department of Cardiology, Balikesir, Turkey. erkayh@gmail.com
• Kardiol Pol. 2013 Jan 1; 71 (2): 165-75.

BackgroundIncompleted ST segment resolution (STR) after primary percutaneous coronary intervention (PCI) is associated with worse clinical outcomes.AimTo investigate the association between plasma N-terminal pro B-type natriuretic peptide (NT-proBNP) levels on admission and STR after reperfusion, in a patient with ST-segment elevation myocardial infarction (STEMI) undergoing primary PCI.MethodsAfter exclusion, 81 consecutive patients with STEMI (mean age: 61.3 ± 13.4 years) undergoing primary PCI were prospectively enrolled in this study. Patients were divided into two groups according to ST-segment resolution: ΣSTR < 50%, the no-reflow phenomenon positive (+) group (n = 20), and ΣSTR ≥ 50%, the no-reflow phenomenon negative (-) group (n = 61). Patients were followed up for six months.ResultsThe no-reflow phenomenon (+) group had similar baseline cardiovascular risk factors (e.g. age, sex, hypertension, diabetes mellitus) but higher mid-term mortality (25% vs. 6.5%, p = 0.02) than the no-reflow phenomenon (-) group. The frequency of anterior MI in the no-reflow phenomenon (+) group was higher (75%, p = 0.02). NT-proBNP levels on admission were higher in the no-reflow phenomenon (+) group (p = 0.001). A NT-proBNP level ≥ 563.4 pg/mL measured on admission had a 72.7% sensitivity and 72.9% specificity in predicting no-reflow phenomenon at ROC curve analysis. At multivariate analysis, anterior MI, high NT-proBNP levels, prolonged chest pain-to-reperfusion time (> 6 h) and post-TIMI-3 flow were independent predictors of no-reflow phenomenon after primary PCI.ConclusionsPlasma NT-proBNP level on admission is a strong and independent predictor of no-reflow phenomenon following primary PCI and mid-term cardiovascular mortality in patients with STEMI.

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