title: B-type natriuretic peptides and ejection fraction for prognosis after myocardial infarction.
abstract: BACKGROUND
  A recent landmark report has demonstrated that plasma B-type natriuretic peptide (BNP) measured in acute coronary syndromes independently predicts mortality, heart failure, and new myocardial infarction. After acute cardiac injury, left ventricular ejection fraction (LVEF) is also of prognostic significance and plays a major role in determining the therapeutic response.
  
  
  RESULTS
  The present report is the first from a substantial (n=666) cohort of patients with acute myocardial infarction to test the prognostic utility of concurrent measurements of BNP, amino-terminal BNP (N-BNP), norepinephrine, and radionuclide LVEF. The B-type peptides and LVEF were predictors of death, heart failure, and new myocardial infarction (all P<0.001) independent of patient age, gender, previous myocardial infarction, antecedent hypertension or diabetes, previous heart failure, plasma norepinephrine, creatinine, cholesterol, drug therapy, and coronary revascularization procedures. The combination of N-BNP (or BNP) with LVEF substantially improved risk stratification beyond that provided by either alone. Elevated N-BNP (or BNP) predicted new myocardial infarction only in patients with LVEF <40%. LVEF <40% coupled to N-BNP over the group median conferred substantial 3-year risks of death, heart failure, and new myocardial infarction of 37%, 18%, and 26%, respectively. N-BNP and BNP were equivalent prognostic markers for these clinical outcomes.
  
  
  CONCLUSIONS
  Plasma N-BNP (or BNP) and LVEF are complementary independent predictors of major adverse events on follow-up after myocardial infarction. Combined measurement provides risk stratification substantially better than that provided by either alone.
authors.affiliation: Christchurch Cardioendocrine Research Group, Christchurch School of Medicine and Health Sciences, PO Box 4345, Christchurch, New Zealand. mark.richards@cdhb.govt.nz
authors.forename: A Mark
authors.initials: AM
authors.lastname: Richards
authors.forename: M Gary
authors.initials: MG
authors.lastname: Nicholls
authors.forename: Eric A
authors.initials: EA
authors.lastname: Espiner
authors.forename: John G
authors.initials: JG
authors.lastname: Lainchbury
authors.forename: Richard W
authors.initials: RW
authors.lastname: Troughton
authors.forename: John
authors.initials: J
authors.lastname: Elliott
authors.forename: Christopher
authors.initials: C
authors.lastname: Frampton
authors.forename: John
authors.initials: J
authors.lastname: Turner
authors.forename: Ian G
authors.initials: IG
authors.lastname: Crozier
authors.forename: Timothy G
authors.initials: TG
authors.lastname: Yandle
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D009320:Atrial Natriuretic Factor / Q000097:blood*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology* / Q000628:therapy; D020097:Natriuretic Peptide, Brain; D009419:Nerve Tissue Proteins / Q000097:blood; D009638:Norepinephrine / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D015635:Radionuclide Ventriculography; D012016:Reference Values; D018570:Risk Assessment; D013318:Stroke Volume; D015996:Survival Rate; D016277:Ventricular Function, Left
chemical_list: D009419:Nerve Tissue Proteins; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D009320:Atrial Natriuretic Factor; D009638:Norepinephrine