Journal of Thrombosis and Thrombolysis

, Volume 34, Issue 1, pp 106–113 | Cite as

Baseline NT-proBNP and biomarkers of inflammation and necrosis in patients with ST-segment elevation myocardial infarction: insights from the APEX-AMI trial

  • Sean van DiepenEmail author
  • Matthew T. Roe
  • Renato D. Lopes
  • Amanda Stebbins
  • Stefan James
  • L. Kristin Newby
  • David J. Moliterno
  • Franz-Josef Neumann
  • Justin A. Ezekowitz
  • Kenneth W. Mahaffey
  • Judith S. Hochman
  • Christian W. Hamm
  • Paul W. Armstrong
  • Pierre Theroux
  • Christopher B. Granger


Coronary plaque rupture is associated with a systemic inflammatory response. The relationship between baseline N-terminal pro B-type natriuretic peptide (NT-proBNP), a prognostic marker in patients with acute coronary syndromes, and systemic inflammatory mediators in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI) is not well described. Of 5,745 STEMI patients treated with primary PCI in the APEX-AMI trial, we evaluated the relationship between baseline NT-proBNP levels and baseline levels of inflammatory markers and markers of myonecrosis in a subset of 772 who were enrolled in a biomarker substudy. Spearman correlations (r s) were calculated between baseline NT-proBNP levels and a panel of ten systemic inflammatory biomarkers. Interleukin (IL)-6, a pro-inflammatory cytokine, was significantly positively correlated with NT-proBNP (r s = 0.317, P < 0.001). In a sensitivity analysis excluding all heart failure patients, the correlation between baseline IL-6 and NT-proBNP remained significant (n = 651, r s = 0.296, P < 0.001). A positive association was also observed with high sensitivity C-reactive protein (r s = 0.377, P < 0.001) and there was a weak negative correlation with the anti-inflammatory cytokine IL-10 (r s = −0.109, P = 0.003). No other significant correlations were observed among the other testes inflammatory cytokines and chemokines. In STEMI patients undergoing primary PCI, the pro-inflammatory cytokine IL-6 was modestly correlated with baseline NT-proBNP levels. This relationship remained significant in patients without heart failure. This finding is consistent with pre-clinical and clinical research suggesting that systemic inflammation may influence NT-proBNP expression independently of myocardial stretch.


N-terminal pro-brain natriuretic peptide Interleukin-6 Interleukin-10 C-reactive protein 



The APEX-AMI trial from which this work was derived, was supported by a research grant jointly funded from Procter & Gamble and Alexion Pharmaceuticals.


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Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Sean van Diepen
    • 1
    • 2
    Email author
  • Matthew T. Roe
    • 1
  • Renato D. Lopes
    • 1
  • Amanda Stebbins
    • 1
  • Stefan James
    • 3
  • L. Kristin Newby
    • 1
  • David J. Moliterno
    • 4
  • Franz-Josef Neumann
    • 5
  • Justin A. Ezekowitz
    • 2
  • Kenneth W. Mahaffey
    • 1
  • Judith S. Hochman
    • 6
  • Christian W. Hamm
    • 7
  • Paul W. Armstrong
    • 2
  • Pierre Theroux
    • 8
  • Christopher B. Granger
    • 1
  1. 1.Duke Clinical Research InstituteDuke University Medical CenterDurhamUSA
  2. 2.Division of CardiologyUniversity of AlbertaEdmontonCanada
  3. 3.Department of Medical Sciences CardiologyUppsala UniversityUppsalaSweden
  4. 4.Gill Heart InstituteUniversity of KentuckyLexingtonUSA
  5. 5.Herz-Zentrum Bad KrozingenBad KrozingenGermany
  6. 6.School of MedicineNew York UniversityNew YorkUSA
  7. 7.Kerckhoff Heart CenterBad NauheimGermany
  8. 8.Institute de Cardiologie de MontréalUniversity de MontréalMontrealCanada

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