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158 J KARDIOL 2008; 15 (5–6)

ÖKG-Jahrestagung – Abstracts

mobilization factor for hematopoietic progenitor cells, whereas mo-

nocyte chemoattractant protein 1 (MCP-1) and macrophage colony

stimulating factor (M-CSF) are essential cytokines for recruitment

and survival of monocytic progenitor cells and macrophages.

Methods G-CSF, MCP-1 and M-CSF protein was determined in

baseline plasma of 360 patients (mean age 72 ± 13 years) with ad-

vanced heart failure with a mean BNP 678.98 ± 760.45 pg/ml and

LVEF of 28.8 ± 10 % by specific ELISAs. 35 % of the patients were

females. During a median follow-up period of 16 month (confi-

dence interval [CI]: 15–17) 92 patients died (26 %), death was used

as endpoint.

Results While plasma levels of G-CSF were not significantly dif-

ferent in the event group (27.95 ± 20.25 vs 25.55 ± 21.37 pg/ml;

p = 0.064) MCP-1 (103.54 ± 76.81 vs 87.46 ± 64.18 pg/ml;

p = 0.036) and M-CSF (659.5 ± 413.13 vs 434.25 ± 343.88 pg/ml;

p < 0.001) were significantly higher in the event group compared to

the event-free group. Univariate Cox regression analysis showed a

trend for a protective effect of G-CSF with a crude proportional haz-

ard ratio (HR) of 0.70 (95 %-CI: 0.42–1.15; p = 0.161) and a signifi-

cant harmful effect of MCP-1 with a HR of 1.78 (95 %-CI: 1.04–

3.04; p = 0.035) for death comparing third to first tertile. Further-

more, we found a significant gradual increase of risk for death with

concentrations of M-CSF with a HR of 2.31 (95 %-CI: 1.31–4.06;

p = 0.004) between the second and the first tertile and a HR of 2.64

(95 %-CI: 1.51–4.62; p = 0.001) between the third and the first

tertile. Applying multivariable analysis (including clinical variables

and BNP) the HR was 1.84 for MCP-1 (95 %-CI: 1.05–3.23;

p = 0.033) and 1.89 for M-CSF (95 %-CI: 1.05–3.4; p = 0.033)

comparing third to first tertile.

Conclusion Our results indicate that higher plasma levels of

MCP-1 and M-CSF are associated with a higher rate of mortality in

heart failure and could serve as independent markers besides BNP.

Therefore we speculate that a prolonged activation of monocytes

and macrophages could have detrimental effects on the injured

myocardium.

Prognostic Relevance of TIMI flow and NT-proBNP

Concentrations in ST-Elevation Myocardial Infarction:

A Substudy of ASSENT IV-PCI 100

R. Jarai, K. Bogearts, W. Droogne, J. Ezekowitz, P. R. Sinnaeve, K. Huber,

C. B. Granger, A. M. Ross, P. W. Armstrong, F. J. Van de Werf, on behalf of the

ASSENT IV-PCI Investigators

Wilhelminenhospital, Vienna, Austria; Leuven, Belgium; Edmonton, Canada;

Durham and Washington D.C., USA

Background We investigated the prognostic significance of

NT-proBNP in addition to TIMI flow determined prior to coronary

intervention in STEMI patients from ASSENT IV-PCI.

Methods Plasma NT-proBNP was available in 1,037 STEMI pa-

tients (pts) when pts were randomized to primary PCI) or to full-

dose tenecteplase prior to PCI (fPCI). The study endpoint was the

composite of death, cardiogenic shock or congestive heart failure at

90 days. The Chi-square (Chi

)

Automatic Interaction Detectors

algorithm (CHAID) of classification-tree analysis comprised our

statistical calculations.

Results Failure of fibrinolytic therapy to achieve TIMI-3 flow

prior to PCI (n = 296) was associated with a significantly higher 90-

day event rate (22.0 %) compared to pts with successful fibrinolysis

(n = 228; 12.7 %; p = 0.006) or primary PCI (TIMI-3 flow n = 66:

13.6 %; p = 0.13; TIMI 0–2 flow n = 425: 12.0 %; p < 0.001).

In latter group prePCI TIMI flow had no influence on clinical out-

come. According to CHAID-analyses, patients with NT-proBNP

> 694 pg/ml (> 80

percentile) had highest risk for 90-day events

in both treatment arms (pPCI: 30.1 %, and fPCI: 36.3 %; p = 0.4)

irrespective of TIMI-flow grade before PCI (Figure 3). The lowest

90-day event rate was observed in patients with a TIMI-3 flow

before PCI pre-treated with fibrinolysis and NT-proBNP levels

≤ 694 pg/m. However, in fibrinolytic nonresponders (TIMI 0–2

flow) event rates were significantly higher than in all other groups.

Conclusion Clinical outcome of pts with high baseline plasma

concentrations of NT-proBNP was poor irrespective of TIMI-flow

before PCI or the assigned treatment. By contrast in pts with low

NT-proBNP levels outcome appeared modulated by prePCI TIMI

flow when pre-treated with fibrinolysis.

Relation of NT-proBNP and Time to Treatment to

Outcome of Patients with ST-Elevation Myocardial

Infarction: an ASSENT IV-PCI Substudy 101

R. Jarai, K. Bogearts, W. Droogne, J. Ezekowitz, P. R. Sinnaeve, K. Huber,

C. B. Granger, A. M. Ross, P. W. Armstrong, F. J. Van de Werf, on behalf of the

ASSENT IV-PCI Investigators

Wilhelminenhospital, Vienna, Austria; Leuven, Belgium; Edmonton, Canada;

Durham and Washington D.C., USA

Background Survival of ST-elevation myocardial infarction

(STEMI) pts depends on time between symptom onset and coronary

reperfusion. In the present substudy from ASSENT IV-PCI pts were

randomly assigned to primary PCI (pPCI) or fibrinolytic-facilitated

PCI (fPCI), and we investigated, whether elevated Nt-proBNP in

the acute phase of STEMI relates to time to reperfusion and inde-

pendently predicts outcome irrespective of time.

Methods Plasma NT-proBNP was available in 1,037 STEMI

patients when pts were randomized to primary PCI) or to full-dose

tenecteplase prior to PCI (fPCI).The study endpoint was the com-

posite of death, cardiogenic shock or congestive heart failure at

90 days. The Chi-square (Chi

) Automatic Interaction Detectors

algorithm (CHAID) of classification-tree analysis comprised our

statistical calculations.

Results NT-proBNP concentrations and time-to-treatment showed

a weak but significant linear correlation (r = 0.22; p < 0.001). Using

time-intervals specified by international guidelines (< 3 h vs ≥ 3h)

median NT-proBNP was significantly higher in pts with longer

delay to treatment (pPCI: 90 pg/ml vs 207 pg/ml, p < 0.001; fPCI:

125 pg/ml vs 248 pg/ml, p < 0.001). Using shorter conventional

time-intervals (< 2 h, 2–4 h and > 4 h) similar increases of NT-

proBNP with time-to-treatment in both study arms (pPCI: 76 pg/ml,

163 pg/ml and 237 pg/ml, p < 0.001; fPCI: 103 pg/ml, 158 pg/ml

and 375 pg/ml, p < 0.001) were evident. However, pts with NT-

proBNP levels > 694 pg/ml (> 80

percentile) had higher 90-day

event rates irrespective of time-to-treatment and the reperfusion-

strategy used. Among patients with NT-proBNP of ≤ 694 pg/ml, 90-

day event rates increased non-significantly in both treatment groups

with increasing time-delay: however they were lower when PCI was

performed < 2 hours after symptom onset whereas the highest event

rates were associated with fPCI treated > 4 hours (p = 0.01 for

trend).

Conclusion Patients with elevated NT-proBNP early in the

course of STEMI have a significantly increased 90-day event rates

irrespective of the treatment delay and reperfusion strategy. It is fea-

Figure 3:

R. Jarai et al.

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