Prehospital electrocardiographic acuteness score of ischemia is inversely associated with neurohormonal activation in STEMI patients with severe ischemia
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Prehospital electrocardiographic acuteness score of ischemia is inversely associated with neurohormonal activation in STEMI patients with severe ischemia. / Fakhri, Yama; Schoos, Mikkel Malby; Sejersten, Maria; Ersbøll, Mads; Valeur, Nana; Køber, Lars; Hassager, Christian; Wagner, Galen S; Kastrup, Jens; Clemmensen, Peter.
in: J ELECTROCARDIOL, Jahrgang 50, Nr. 1, 27.11.2016, S. 90-96.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Prehospital electrocardiographic acuteness score of ischemia is inversely associated with neurohormonal activation in STEMI patients with severe ischemia
AU - Fakhri, Yama
AU - Schoos, Mikkel Malby
AU - Sejersten, Maria
AU - Ersbøll, Mads
AU - Valeur, Nana
AU - Køber, Lars
AU - Hassager, Christian
AU - Wagner, Galen S
AU - Kastrup, Jens
AU - Clemmensen, Peter
N1 - Copyright © 2016 Elsevier Inc. All rights reserved.
PY - 2016/11/27
Y1 - 2016/11/27
N2 - 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 24hours 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.
AB - 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 24hours 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.
KW - Acute Disease
KW - Biomarkers/blood
KW - Denmark
KW - Electrocardiography/methods
KW - Emergency Medical Services/statistics & numerical data
KW - Female
KW - Humans
KW - Incidence
KW - Male
KW - Middle Aged
KW - Myocardial Ischemia/blood
KW - Natriuretic Peptide, Brain/blood
KW - Peptide Fragments/blood
KW - Reproducibility of Results
KW - Risk Assessment/methods
KW - Risk Factors
KW - ST Elevation Myocardial Infarction/blood
KW - Sensitivity and Specificity
KW - Severity of Illness Index
U2 - 10.1016/j.jelectrocard.2016.11.002
DO - 10.1016/j.jelectrocard.2016.11.002
M3 - SCORING: Journal article
C2 - 27887720
VL - 50
SP - 90
EP - 96
JO - J ELECTROCARDIOL
JF - J ELECTROCARDIOL
SN - 0022-0736
IS - 1
ER -