title: MR-proANP improves prediction of mortality and cardiovascular events in patients with STEMI.
abstract: BACKGROUND
  Atrial natriuretic peptide (ANP) is released from the atria (on cleavage of proANP) in response to elevated intra-atrial pressure and wall stretch. Clinical data on proANP are still limited, mainly due to limitations in assaying the protein, which recently have been solved. ProANP is elevated in cardiovascular disease and predicts outcome in heart failure. However, knowledge of the prognostic value in acute myocardial infarction remains limited.
  
  
  METHODS
  We prospectively included 680 patients with STEMI treated with primary-PCI, from September 2006 to December 2008. Blood samples were drawn immediately before PCI. Plasma MR-proANP was measured using an automated processing assay. Endpoints were all-cause mortality (n = 137) and the combined endpoint (n = 170) of major adverse cardiovascular events (MACE) defined as cardiovascular mortality and admission due to recurrent MI, ischaemic stroke or heart failure.
  
  
  RESULTS
  During 5-year follow-up, MR-proANP was associated with increased risk of all-cause mortality and MACE (both p < 0.001). After adjustment for confounding risk factors (age, gender, hypertension, diabetes, hypercholesterolaemia, smoking, previous MI, BMI, eGFR, CRP, peak-TnI, symptom-to-balloon time, multivessel disease, complex lesion, LAD-lesion and use of glycoprotein inhibitor), MR-proANP remained an independent predictor of all-cause mortality and MACE - hazard ratio: 1.68 (95% CI 1.35-2.10; p < 0.001) and 1.68 (95% CI 1.39-2.03; p < 0.001) per standard deviation increase in MR-proANP. MR-proANP significantly increased C-statistics and reclassified 26% of the patients for all-cause mortality and 34% for MACE into higher or lower risk categories, matching actual event rates more accurately.
  
  
  CONCLUSIONS
  Plasma MR-proANP independently predicts all-cause mortality and MACE in patients with STEMI.
authors.affiliation: Department of Cardiology P, Gentofte University Hospital, Copenhagen, Denmark soerenli@hotmail.com.
authors.forename: Søren
authors.initials: S
authors.lastname: Lindberg
authors.affiliation: Department of Cardiology P, Gentofte University Hospital, Copenhagen, Denmark Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Denmark.
authors.forename: Jan Skov
authors.initials: JS
authors.lastname: Jensen
authors.affiliation: Department of Cardiology P, Gentofte University Hospital, Copenhagen, Denmark.
authors.forename: Sune H
authors.initials: SH
authors.lastname: Pedersen
authors.affiliation: Department of Cardiology P, Gentofte University Hospital, Copenhagen, Denmark.
authors.forename: Søren
authors.initials: S
authors.lastname: Galatius
authors.affiliation: Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Jens P
authors.initials: JP
authors.lastname: Goetze
authors.affiliation: Department of Cardiology P, Gentofte University Hospital, Copenhagen, Denmark.
authors.forename: Rasmus
authors.initials: R
authors.lastname: Mogelvang
mesh_terms: D000368:Aged; D019540:Area Under Curve; D009320:Atrial Natriuretic Factor / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D002423:Cause of Death; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis* / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy; D010359:Patient Readmission; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012372:ROC Curve; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000097:blood / Q000401:mortality; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood; D015854:Up-Regulation; D016277:Ventricular Function, Left
chemical_list: D015415:Biomarkers; D019210:Troponin I; C552580:midregional pro-atrial natriuretic peptide, human; D009320:Atrial Natriuretic Factor; D002097:C-Reactive Protein
keywords: STEMI; myocardial infarction; outcome; proANP