Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
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N-Terminal Pro-B-Type Natriuretic Peptide as a Prognostic Marker in Acute Coronary Syndrome

급성 관동맥 증후군 환자에서 예후 지표로서 N-Terminal Pro-B-Type Natriuretic Peptide의 유용성

Baek, Kyung-Kee;Jeon, Eun-Seok;Rhee, Il;Kim, Sung-Hea;Kim, Je-Sang;Song, Pil-Sang;Ryu, Dong-Ryeol;Choi, Jin-Ho;Sung, Ji-Dong;Lee, Sang-Chol;Park, Seung-Woo;Gwon, Hyun-Cheol;Kim, June-Soo;Kim, Duk-Kyung;Lee, Sang-Hoon;Hong, Kyung-Pyo;Park, Jeong-Euy
백경기;전은석;이일;김성해;김제상;송필상;류동열;최진호;성지동;이상철;박승우;권현철;김준수;김덕경;이상훈;홍경표;박정의

  • Published : 20041100
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Abstract

Background and Objectives : Biochemical markers are useful for the prediction of cardiac events in patients with acute coronary syndrome (ACS). The N-terminal fragment of the BNP prohormone (NT-proBNP), which is synthesized by cardiac ventricles in response to increased wall stress, may be a prognostic marker in ACS. The relation between the NT-pro BNP levels on admission and major adverse cardiovascular events (MACEs) were assessed in a cohort of patients with ACS. Subjects and Methods : Between October 2002 and April 2004, blood samples for the determination of NT-proBNP level were obtained on admission from 78 patients with ST-elevation myocardial infarction (STEMI), 32 with non-ST elevation MI (NSTEMI) and 66 with unstable angina (UA). Patients were followed concerning MACEs (death, MI, heart failure, stroke and revascularization) for a median of 7 months in median. Results : 22 patients (13%) had events. The mean NTproBNP level was significantly lower in the event-free survivors than in those with events (1342$\pm$1598 versus 6129$\pm$ 6522 pg/mL, p<0.0001). The optimal cut-off value of the NT-proBNP level using a receiver-operating-characteristic curve was 1445 pg/mL. The unadjusted risk ratio of patients with an NT-proBNP level greater than the threshold was 7.0 (95% confidence interval, 2.6 to 19.0). In a multivariate Cox regression model, including clinical background factors and other biochemical markers, the NT-proBNP level was the most powerful indicator of MACEs (risk ratio, 8.0 [95% confidence interval, 1.7 to 37.1]). The coronary angiographic Gensini score was also a predictor of prognosis in ACS (risk ratio, 3.8 [95% confidence interval, 1.0 to 14.0]). Conclusion : A single measurement of the NT-proBNP level on admission appears to be useful as a prognostic factor in the prediction of MACEs in patients after ACS.

배경 및 목적 : 급성 관동맥 증후군환자의 예후를 예측하는데 생화학적 지표들이 유용한 것으로 보고되고 있다. NT-proBNP는 심실벽의 증가된 압력과 긴장에 반응하여 주로 심실에서 생산되는 호르몬으로 급성 관동맥 증후군에서 예후지표로 사용될 수 있다. 입원 시 측정한 혈중 NTproBNP치와 치료 후 발생하는 major adverse cardiovascular events(MACEs)를 추적 관찰하여 예후지표로서 NT-proBNP의 유용성을 평가하고자 하였다. 방법 : 2002년 8월부터 2004년 4월까지 급성 관동맥 증후군으로 진단 받아 삼성 서울 병원 심장내과 중환자실에 입원한 환자 176명을 대상으로 7개월(중앙값)간의 기간 동안 심혈관 질환으로 인한 사망, 심근경색, 심부전, 뇌졸중, 혈관개통여부와 같은 major adverse cardiovascular events의 발생여부를 추적 관찰하였다. 결과 : 22명(13%)의 환자에서 MACEs가 발생하였다. MACEs가 발생하지 않은 환자군보다 발생한 환자군에서 혈중 NT-proBNP치가 유의하게 높았다(1342$\pm$1598 pg/mL versus 6129$\pm$6522 pg/ml, p<0.0001). ROC curve를 분석한 결과 MACEs에 대한 혈중 NT-pro-BNP치의 가장 적절한 cut-off 수치는 1445 pg/mL 였다. 혈중 NT-proBNP치가 cut-off치 이상($\geq$1445 pg/mL)인 환자들의 미만인 환자들에 대한 비교위험도는 7.00(95% 신뢰구간, 2.57-19.0)였다. 다른 생화학적 표시자와 임상적인 위험인자를 포함하는 다중 회귀 분석결과 혈중 NT-proBNP치가 cut-off수치 이상인 환자들의 미만인 환자들에대한 비교위험도가 8.01(95% 신뢰구간, 1.73-37.1)였다. 관동맥 조영에서 협착의 정도를 반정량화한 Gensini score도 MACEs에대한 예측인자로서 통계적으로 유의하였다(비교위험도, 3.8 [95% 신뢰구간, 1.0-14.0]). 결론 : 급성 관동맥 증후군환자에서 입원 시 측정한 NTproBNP치는 이후 발생하는 MACEs를 예측하는데 유용한 생화학적 표시자이다.

Keywords

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