Plasma catecholamines and N-terminal proBNP in patients with acute myocardial infarction undergoing primary angioplasty. Relation to left ventricular function and clinical outcome.
BACKGROUND
Neither profiles nor prognostic values of neurohormonal markers have been prospectively evaluated in patients with acute myocardial infarction (AMI) undergoing primary angioplasty.


RESULTS
In 118 consecutive patients with AMI undergoing successful reperfusion (TIMI 2 and 3) by primary angioplasty, plasma concentrations of norepinephrine, epinephrine and N-terminal proBNP (NT-proBNP) were measured before, 60 min and 10 days after angioplasty. Catecholamine concentrations (mean+/-SEM) rose to a maximum in the first hour after angioplasty (norepinephrine: 602+/-44 ng/L, epinephrine: 213+/-24 ng/L) and returned to normal at day 10. Conversely, NT-proBNP levels maintained a further increase from 799+/-44 pmol/L at baseline to 924+/-54 pmol/L at day 10. A NT-proBNP concentration above median at 60 min post-angioplasty predicted major adverse cardiac events (n=27) during the 18-36 month follow-up with an odds ratio of 5.9 (1.7-20.3) and was superior to catecholamines, to left ventricular ejection fraction and to other established postinfarction risk markers.


CONCLUSIONS
In a low-risk cohort of patients with AMI undergoing successful reperfusion therapy, plasma NT-proBNP concentrations are elevated for at least ten days. The prognostic value of early plasma NT-proBNP should be further evaluated concerning its ability to facilitate risk stratification of infarct patients.
Hartmann
F
F
Medizinische Klinik II, UK Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany. hartmann@medinf.mu-luebeck.de
Kurowski
V
V
Maghsoudi
A
A
Kurz
T
T
Schwarz
M
M
Bonnemeier
H
H
Tölg
R
R
Jain
D
D
Wiegand
U
U
Katus
H
H
Richardt
G
G
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D004837:Epinephrine / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology*; D009203:Myocardial Infarction / Q000097:blood / Q000401:mortality / Q000628:therapy*; D020097:Natriuretic Peptide, Brain; D009419:Nerve Tissue Proteins / Q000097:blood*; D009638:Norepinephrine / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011379:Prognosis; D012008:Recurrence; D018570:Risk Assessment; D013318:Stroke Volume / Q000502:physiology*; D016019:Survival Analysis; D016896:Treatment Outcome
D009419:Nerve Tissue Proteins; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D009638:Norepinephrine; D004837:Epinephrine