Natriuretic peptides as an adjunctive treatment for acute myocardial infarction: insights from the meta-analysis of 1,389 patients from 20 trials.
Animal studies have reported a cardioprotective effect for atrial natriuretic peptide (ANP) or brain natriuretic peptide (BNP) administration in the setting of acute myocardial infarction (AMI). However, previous trials performed on AMI patients have reported differences in the cardiac function protection for ANP/BNP infusion, making it diffi cult to confirm the beneficial effect of natriuretic peptides. We performed a meta-analysis of all available trials to determine whether ANP/BNP infusion was effective in improving cardiac function.


METHODS
We searched various databases including PubMed, EMBASE, Web of Knowledge, the Cochrane Library, and CKNI for studies related to ANP/BNP infusion in AMI. The major outcome was left ventricular ejection fraction (LVEF).


RESULTS
Twenty trials (4 for ANP, 16 for BNP) with 1389 patients were included. There were no significant differences in patient characteristics between the ANP/BNP infusion and control groups at baseline. Pooled analysis showed that patients in the ANP/BNP infusion group had significantly higher LVEF than in the control during follow-up [Studies on ANP: weighted mean differences (WMD) 2.94%, 95% confidence interval (CI): 1.39%-4.50%, P = 0.0002; Studies on BNP: WMD 4.45%, 95%CI: 2.25%-6.65%, P < 0.0001].


CONCLUSIONS
The present meta-analysis suggested that ANP/BNP infusion might be effective in protecting left ventricular function in patients with AMI. ANP/BNP infusion may be an effective adjunctive therapy for cardiac function protection in AMI patients.
Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University.
Ting
T
Lyu
Yichao
Y
Zhao
Tuo
T
Zhang
Wen
W
Zhou
Fan
F
Yang
Heng
H
Ge
Song
S
Ding
Jun
J
Pu
Ben
B
He
D000818:Animals; D009320:Atrial Natriuretic Factor / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D006801:Humans; D009203:Myocardial Infarction / Q000188:drug therapy*; D045283:Natriuretic Agents / Q000627:therapeutic use*; D020097:Natriuretic Peptide, Brain / Q000627:therapeutic use*
D045283:Natriuretic Agents; D020097:Natriuretic Peptide, Brain; D009320:Atrial Natriuretic Factor