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

• Published in: Journal of the American College of Cardiology Vol. 51; no. 19; pp. 1857 - 1864
• Main Authors: KHAN, Sohail Q, DHILLON, Onkar, KELLY, Dominic, SQUIRE, Iain B, STRUCK, Joachim, QUINN, Paulene, MORGENTHALER, Nils G, BERGMANN, Andreas, DAVIES, Joan E, NG, Leong L
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Science 13.05.2008; Elsevier Limited
• Subjects: Adult; Aged; Aged, 80 and over; Angina pectoris; Atrial Natriuretic Factor - blood; Biological and medical sciences; Biomarkers - blood; Cardiology; Cardiology. Vascular system; Coronary heart disease; Female; Heart; Heart attacks; Heart Failure; Humans; Male; Medical sciences; Middle Aged; Mortality; Myocardial Infarction - blood; Myocardial Infarction - diagnostic imaging; Myocardial Infarction - mortality; Myocarditis. Cardiomyopathies; Natriuretic Peptide, Brain - blood; Plasma; Prognosis; Prospective Studies; Recurrence; Risk Assessment; Rodents; Time Factors; Ultrasonography; Myocardial infarction; Brain natriuretic peptide; Prognosis; Acute; Cardiovascular disease; Atrial natriuretic peptide; N terminal peptide; Coronary heart disease; Myocardial disease; Long term; Survival; Indicator; Blood plasma; Circulatory system; Cardiology; Comparative study
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2008.01.041

Our aim was to assess the prognostic value of midregional pro-atrial natriuretic peptide (MR-proANP) in patients after acute myocardial infarction (AMI). 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. 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. 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. 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.