الفهرس | Only 14 pages are availabe for public view |
Abstract SUMMARY cute coronary syndromes without ST elevation encompass a wide range of events and have different prognostic values in relation to the type of plaque lesions and the diffusion of coronary atherosclerosis. The risk assessment, based on clinical history and examination, electrocardiographic (ECG) characteristics, and markers of myocardial damage, still remains relatively inaccurate. The risks of subsequent death and/or recurrent ischemic events also vary widely, depending on the presence of myocardial ischemic areas, irreversible myocyte injury, the hemodynamic consequences of ischemia and the extent of coronary atherosclerosis. B-type natriuretic peptide (BNP) is a peptide consisting of 32 amino acids produced by the myocytes as a prohormone. It is released in response to ventricular dilatation and pressure overload, in its active form after peptidase degradation, into the cardiovascular system. This study was carried out in the cardiology department of Ain Shams University Hospitals from January to July 2015 to find the relation between the BNP level and severity of coronary artery disease as assessed by Gensini score in patients who presented with unstable angina and non ST elevation myocardial infarction This study included 90 patients who were admitted with diagnosis NSTE-ACS and underwent coronary angiography. We found Patients’ age was ranging from 39 years to 73 years with a mean and SD was 57.16 ± 7.90, of this population 56.7% (51) were males and 43.3% (39) were females.58.9% (53) were smokers, 70% (63) were hypertensive or on antihypertensive treatment, 53.3% (48) were diabetic and 26.7% (24) were dyslipidemic. We demonstrated that BNP threshold of 80 pg/ml appears able to predict the extension of coronary disease independently from LV systolic dysfunction and enlargement. from this study, we found that BNP level significantly higher in patients with NSTEMI than in patients with unstable angina (169.64 ± 64.31 pg / ml vs. 63.53 ± 22.61 pg / ml, p. value < 0.001). Also we found that LAD affection was significantly higher in patients with BNP > 80 pg/ml than in patients with BNP < 80 pg/ml [40 of 49 patients (81.6%) vs. 19 of 41 patients (46.3%), p. value < 0.001]. It was also found that MVD affection was significantly higher in patients with BNP > 80 pg/ml than in patients with BNP <80 pg/ml [30 of 49 patients (61.2%) vs. 14 of 41 patients (34.1%), p. value 0.01]. Our study demonstrated that BNP level was high in patients with NSTEMI, multivessel disease and left anterior descending artery affection even in the absence of LV systolic dysfunction. from this study we recommended that BNP should be routinely measured to aid more strong evidence of risk stratification and also to predict the LAD and multivessel disease affection. |