BACKGROUNDPrevious studies showed that blood B-type natriuretic peptide (BNP) level could predict the prognosis of acute coronary syndromes (ACS). This study investigated the evaluation value of circulating BNP for early percutaneous coronary intervention (PCI) in patients with ACS.

METHODSNine hundred and sixty consecutive patients with ACS were enrolled. Circulating BNP level was measured when each patient arrived at the emergency room. All patients underwent PCI in 90 minutes in spite of contraindication. Cardiac events (death from any cause, heart failure, and recurrence of acute myocardial infarction or ACS) were recorded during follow-up.

RESULTSIn patients with BNP > or = 80 pg/ml, mortality from all causes within 1 month and 6 months in those underwent delayed PCI (> or = 6 hours) was significantly higher than those received early PCI (< 6 hours) (9.53% vs 3.49%, P = 0.027; 13.61% vs 5.24%, P = 0.010, respectively). Similarly, the incidence rate of heart failure in delayed PCI patients was significantly higher than those received early PCI within 1 month and 6 months (12.93% vs 4.66%, P = 0.008; 14.97% vs 6.98%, P = 0.021, respectively). The recurrence rate of acute myocardial infarction or ACS, however, was not significantly different between early PCI and delayed PCI patients in group BNP > or = 80 pg/ml. In patients with BNP < 80 pg/ml, no significant difference was observed between early PCI and delayed PCI patients with any of the above cardiac events within 1 month or 6 months.

CONCLUSIONWhile early level of circulating BNP > or = 80 pg/ml, the incidence of mortality and heart failure, but not recurrence of acute myocardial infarction, is significantly reduced in patients with ACS provided by early PCI.