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To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ahj.2010.04.011 Byline: Nisha Mistry (a), Ellen BA[cedilla]hmer (b), Pavel Hoffmann (c), Carl Muller (d), Reidar BjA[cedilla]rnerheim (a), Sverre E. Kjeldsen (a), Sigrun Halvorsen (a) Abstract: Thrombolysis remains the treatment of choice in acute ST-segment elevation myocardial infarction (STEMI) when primary percutaneous coronary intervention (PCI) cannot be performed within 90 to 120 minutes. The optimal treatment after thrombolysis is still debated, but several studies have shown improved clinical outcomes with early transfer for PCI. The aim of this study was to investigate whether an early invasive strategy after thrombolysis preserved left ventricular function better than a late invasive strategy. Author Affiliation: (a) Department of Cardiology, Oslo University Hospital Ullevaal, Oslo, Norway (b) Department of Medicine, Innlandet Hospital Trust, Lillehammer, Norway (c) Department of Radiology, Oslo University Hospital Ullevaal, Oslo, Norway (d) Department of Nuclear Medicine, Oslo University Hospital Ullevaal, Oslo, Norway Article History: Received 8 February 2010; Accepted 14 April 2010 Article Note: (footnote) RCT #NCT00161005.

A randomized, controlled trial, known as the Autologous Stem-Cell Transplantation in Acute Myocardial Infarction (ASTAMI) study, was conducted to investigate whether intracoronary injection of autologous mononuclear bone marrow (BMC) results in a clinically important improvement in left ventricular function as measured by the left ventricular ejection factor (LVEF). Results showed no effects of intracoronary injection of autologous mononuclear BMC on global left ventricular function.

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Background: N-terminal pro-B-type natriuretic peptide (NT-proBNP) appears to be a strong risk marker of mortality in patients with acute coronary syndrome. However, little information is available on NT-proBNP as a predictor of long-term serious cardiovascular events beyond that of left ventricular ejection fraction in patients with acute myocardial infarction (AMI), most of them treated with an early invasive strategy and on a uniform optimal secondary preventive medication including long-term beta-adrenergic receptor blockade., Objective: To assess the prognostic impact of plasma NT-proBNP in patients with AMI who received optimal medical treatment including long-term beta-adrenergic receptor blockade., Methods: Plasma NT-proBNP was measured in 219 patients (age range 31-80 years) with AMI at baseline, and then followed for a median duration of 1.63 years. The first occurrences of a serious cardiovascular event including cardiac mortality, nonfatal MI, and congestive heart failure were registered., Results: Ninety serious cardiovascular events occurred. Left ventricular ejection fraction and reperfusion therapy with thrombolysis or percutaneous coronary intervention were identified as confounders. When adjusting for these factors in multivariate analysis, NT-proBNP was a strong predictor of serious cardiovascular events in patients with a plasma NT-proBNP of >162.2 pmol/l and aged <60 years (p = 0.001). The incidence rate was related to increasing NT-proBNP (p = 0.0017). The risk of serious cardiovascular events was higher in patients with NT-proBNP levels in the highest quartile (> or =162.2 pmol/l) than in those with levels in the three lowest quartiles (rate ratio = 2.5, 95% confidence interval = 1.6-3.9, p = 0.0001)., Conclusion: AMI patients with high plasma NT-proBNP seem to be at an increased risk of serious cardiovascular events, but only those < or =60 years of age., (Copyright 2006 S. Karger AG, Basel.)