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Plasma N-terminal B-Type natriuretic peptide as an indicator of long-term survival after acute myocardial infarction: comparison with plasma midregional pro-atrial natriuretic peptide: the LAMP (Leicester Acute Myocardial Infarction Peptide) study.

Abstract：

OBJECTIVES:Our aim was to assess the prognostic value of midregional pro-atrial natriuretic peptide (MR-proANP) in patients after acute myocardial infarction (AMI). BACKGROUND:Multimarker strategies may assist risk stratification after AMI. Midregional pro-atrial natriuretic peptide is a newly described stable fragment of N-terminal pro-atrial natriuretic peptide. We compared the prognostic value of MR-proANP and an established marker, N-terminal pro-B-type natriuretic peptide (NT-proBNP), after AMI. METHODS:We recruited 983 consecutive post-AMI patients (720 men, median age 65 [range 24 to 95] years) in a prospective study with follow-up over 343 (range 0 to 764) days. RESULTS:Plasma MR-proANP was raised in patients who died (n = 101) compared with that seen in survivors (median 310 [range 48 to 1,150] pmol/l vs. 108 [range 4.9 to 1,210] pmol/l, p < 0.0001). Using Cox modeling, log(10)MR-proANP (hazard ratio 3.87) and log(10)NT-proBNP (hazard ratio 3.25) were significant independent predictors of death. In patients stratified by NT-proBNP in the highest quartile (> approximately 5,900 pmol/l), MR-proANP in the top quartile ( approximately 330 pmol/l) was associated with poorer outcome (p < 0.0001). Findings were similar for heart failure as an individual end point. However, neither marker predicted recurrent AMI. CONCLUSIONS:The A- and B-type natriuretic systems are activated after AMI. Midregional pro-atrial natriuretic peptide is a powerful predictor of adverse outcome, especially in those with an elevated NT-proBNP. Midregional pro-atrial natriuretic peptide may represent a clinically useful marker of prognosis after an AMI as part of a multimarker strategy targeting the natriuretic neurohormonal pathway.

journal_name

J Am Coll Cardiol

journal_title

Journal of the American College of Cardiology

authors

Khan SQ,Dhillon O,Kelly D,Squire IB,Struck J,Quinn P,Morgenthaler NG,Bergmann A,Davies JE,Ng LL

doi

10.1016/j.jacc.2008.01.041

subject

Has Abstract

pub_date

2008-05-13 00:00:00

pages

1857-64

issue

19

eissn

0735-1097

issn

1558-3597

pii

S0735-1097(08)00715-8

journal_volume

51

pub_type

杂志文章

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