الفهرس 
ST ELEVATION MIOnly 14 pages are availabe for public view
 |  | from | 16 |  |  |
| | | from | 16 | | |
Abstract
n 90% of the patients with STEMI, restored epicardial blood flow, defined as TIMI flow grade 3, is achieved after 1ry PCI. However, despite restored epicardial blood flow, a substantial percentage of patients have signs of impaired myocardial reperfusion and therefore have an impaired prognosis.
Early STR better reflects restoration of the myocardial tissue perfusion than TIMI-graded epicardial flow. Unsuc-cessful restoration of microvascular perfusion, despite optimal epicardial flow, may explain the strong association of early STR with mortality.
The aim of this study is to show the value of N-terminal Pro BNP in prediction of STR after 1ry PCI for patients with STEMI, to compare the predictive value of NT-proBNP with other serum biomarkers (cTnT, creatinine kinase-MB fraction, CRP, and serum creatinine) and to identify patients who might particularly benefit from adjunctive therapy aimed at improving microvascular reperfusion.
The present study included 90 patients with STEMI who underwent 1ry PCI; the 90 patients were subjected to the following:
1. Full history taking.
2. Full clinical examination.
3. Resting 12 leads ECG was done before primary PCI with measurement of ST elevation deviation.
4. Blood samples were collected before primary PCI for assessment of the NT-proBNP, cTnT, CK-MB fraction, CRP, and serum creatinine levels. The blood samples were centrifuged without undue delay and stored at -20°C until their analysis.
5. 1ry PCI was done for all patients in standard manner within 12 hours of the onset of patient by trans-femoral approach to the infarct related artery; MBG was scored angiographically.
6. ECG was done at the end of the 1ry PCI to assess STR with measurement of the percentage of change in the average summation of ST segment deviation between the preprocedural and immediately postprocedural ECG, incomplete recovery will be diagnosed if percentage is <50%.
7. Transthoracic echocardiography for measurement of Systolic function by using EF%.
Subjects with the following conditions were excluded from the study:
1) Patient with history of previous coronary artery disease or congestive heart failure.
2) Patients with a missing pre procedural ECG, post procedural ECG, or blood sample.
3) Patients in whom ST-segment recovery could not be assessed, such as those patients with ECG recordings showing complete left bundle branch block, an accelerated idioventricular rhythm, a paced rhythm, severely widened QRS complexes and severe artifacts.
4) Patients who were candidate for 1ry PCI in whom ST-segment elevation had disappeared before beginning of the procedure.
5) Contraindication to 1ry PCI.
6) Patients given adjunctive therapy during 1 ry PCI like ischemic preconditioning, Glycoprotein IIb/IIIa inhibitors, thrombus aspiration by aspiration device, vasodilators like Na nitroprusside, nitoglcerin, Ca channel blockers like verapamil and agents like adenosine.
7) Patients with overt inflammatory conditions or infections, who had an admission CRP level ≥ 20 mg/L.
In the comparison between the 5 cardiac biomarkers regarding the STR there was highly significant relation between each of NT-proBNP, cTnT, CK MB and STR with the highest significance in NT-proBNP. Higher levels of NT-proBNP, CTnT and CK MB were found in STR<50% and lower levels were found with STR≥ 50. No significant relation was found between STR and both of S.Cr &CRP.
The predictive value for STR < 50% is stronger in NT-proBNP than in cTnT and CK MB. The cut off predictive value of NT-proBNP (≥ 420 ng/L) have diagnostic accuracy and area under the curve (AUC) (95.3% and 0.987 respectively).
Regarding the relation of cardiac markers with MBG, there is a highly significant relation between MBG and each of NT-proBNP, nTnT and CK-respectively with more significance in NT-proBNP. Higher levels of NT-proBNP, cTnT and CK-MB were found in MBG (0-1) and lower levels were found in MBG (2-3) while no relation was found between s.Cr, CRP and MBG.
Regarding the relation between STR and MBG, there was a highly significant difference between patients with STR < 50% and those with STR ≥ 50% regarding MBG where MBG (0-1) was found in 54.7%% of Patients with STR <50% and MBG (2-3) in 45.3% of STR< 50% while in STR ≥ 50%, 15.4 % of patients had MBG (0-1) and 84.6% had MBG (2-3).
Regarding the effect of the duration of chest pain, there was a highly significant positive correlation between the duration of chest pain (in hrs) and each of NT-proBNP, cTnT and CK-MB and also a highly significant inverse relation was found between the duration of pain (in hrs) and STR.
Regarding the effect of age, there is a significant positive correlation only between NT-proBNP and age while no significant correlations between other cardiac markers and age. Regarding the effect of age on STR there is no significant relation between age and STR.
Regarding the effect of gender, there is no relation between gender and cardiac markers and between gender and STR.
The present study failed to find a relation between cardiac markers and EF%, site of MI and culprit artery.