ISCHAEMIC HEART DISEASE

NT-proBNP predicts long term mortality ▸

N terminal pro-B-type natriuretic peptide (NT-proBNP) was measured in baseline serum samples from 1034 patients referred for angiography because of symptoms or signs of coronary heart disease. The rate of death from all causes was determined after a median follow up of nine years. At follow up, 288 patients had died. The median NT-proBNP concentration was significantly lower among patients who survived than among those who died (120 pg/ml, interquartile range (IQR) 50–318 pg/ml, v 386 pg/ml, IQR 146–897 pg/ml; p < 0.001). Patients with NT-proBNP concentrations in the highest quartile were older, had a lower left ventricular ejection fraction (LVEF) and a lower creatinine clearance rate, and were more likely to have a history of myocardial infarction, clinically significant coronary artery disease, and diabetes than patients with NT-proBNP concentrations in the lowest quartile. In a multivariable Cox regression model, the hazard ratio for death from any cause for the patients with NT-proBNP concentrations in the fourth quartile as compared with those in the first quartile was 2.4 (95% confidence interval (CI) 1.5 to 4.0; p < 0.001); the NT-proBNP concentration added prognostic information beyond that provided by conventional risk factors, including the patient’s age, LVEF, and the presence or absence of clinically significant coronary artery disease on angiography.

Distal protection does not protect in primary angioplasty ▸

In 501 patients treated with primary angioplasty for ST elevation myocardial infarction (STEMI), 252 patients were assigned to distal protection with the Percusurge system, and the rest to conventional treatment. Co-primary end points were ST segment resolution (STR) measured 30 minutes after percutaneous coronary intervention (PCI) by continuous Holter monitoring and infarct size measured by technetium Tc99m sestamibi imaging between days 5 and 14. Secondary end points included major adverse cardiac events. Among the 252 patients assigned to distal protection, aspiration was performed in 97% (242/251), all angioplasty balloon inflations were …