Plasma natriuretic peptides up to 2 years after acute myocardial infarction and relation to prognosis: an OPTIMAAL substudy.
BACKGROUND
Few studies have compared the relative prognostic value of different natriuretic peptides after acute myocardial infarction (AMI). None has described peptide levels beyond the early post-AMI period. This study describes temporal profiles of 4 natriuretic peptides to 2 years after AMI and relationship with outcome.


RESULTS
We assessed profiles of N-terminal proANP (N-ANP), B-type natriuretic peptide (BNP), N-terminal proBNP (N-BNP), and C-type natriuretic peptide (CNP) (study entry, 1 month, 1 year, and 2 years) in 236 patients with AMI complicated by clinical or radiologic evidence of heart failure. We assessed the prognostic value for baseline levels of each peptide for death or reinfarction. We observed distinct natriuretic peptide profiles. BNP and N-BNP levels were highest at baseline and fell thereafter. N-ANP levels increased from baseline to 30 days and fell thereafter. During follow-up (mean 938 days), 34 patients died and a further 25 suffered nonfatal AMI. Baseline natriuretic peptide levels did not have independent predictive power for outcome. N-BNP levels fell from baseline to 30 days in patients surviving to the end of follow-up (P = .005) but were similar at both times (P = .76) for those dying after 30 days. Age (P < .0005) and change in N-BNP from baseline to 30 days (P = .026) had independent predictive value for death after 30 days.


CONCLUSIONS
N-ANP, BNP, N-BNP, and CNP show distinct plasma profiles after AMI. Failure of plasma N-BNP to fall in the 30 days after AMI indicates adverse prognosis.
Squire
Iain B
IB
University of Leicester Department of Cardiovascular Sciences, Leicester, United Kingdom.
Ørn
Stein
S
Ng
Leong L
LL
Manhenke
Cord
C
Shipley
Lorraine
L
Aarsland
Torbjorn
T
Dickstein
Kenneth
K
D000368:Aged; D000369:Aged, 80 and over; D009320:Atrial Natriuretic Factor / Q000097:blood; D015415:Biomarkers / Q000097:blood*; D003404:Creatinine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000097:blood* / Q000175:diagnosis*; D020097:Natriuretic Peptide, Brain / Q000097:blood; D020098:Natriuretic Peptide, C-Type / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011237:Predictive Value of Tests; D011379:Prognosis; D016019:Survival Analysis
D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D020098:Natriuretic Peptide, C-Type; D009320:Atrial Natriuretic Factor; D003404:Creatinine