title: Prognostic value of serial brain natriuretic Peptide measurements in patients with acute myocardial infarction.
abstract: OBJECTIVE
  Elevated B-type natriuretic peptide (BNP) levels following acute myocardial infarction (AMI) are associated with adverse outcomes. The role of serial BNP monitoring after AMI has been poorly investigated. We aimed to evaluate the prognostic value of in-hospital serial BNP measurements in AMI patients.
  
  
  METHODS
  Patients with AMI (n=1,924) were retrospectively evaluated. We selected patients with at least 2 in-hospital BNP measurements. The association between in-hospital mortality and BNP measurements (earliest, highest follow-up and the variation between measurements) were tested in multivariate models.
  
  
  RESULTS
  Serial BNP levels were determined in 176 patients. Compared to the rest of the population, these patients were older and had higher mortality rates. In the adjusted models, only the highest follow-up BNP remained associated with in-hospital death (odds ratio 1.06; 95% confidence interval, CI, 1.01-1.15; p=0.014). Receiver-operating characteristic curve analysis demonstrated that the highest follow-up BNP was the best predictor of in-hospital death (area under the curve=0.75; 95% CI 0.64-0.86).
  
  
  CONCLUSIONS
  Serial BNP monitoring was performed in a high-risk subgroup of AMI patients. The highest follow-up BNP was a better predictor of short-term death than the baseline and in-hospital variation values. In AMI patients, a later in-hospital BNP assessment may be more useful than an early measurement.
authors.affiliation: Hospital Israelita Albert Einstein, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Antonio E P
authors.initials: AE
authors.lastname: Pesaro
authors.forename: Marcelo
authors.initials: M
authors.lastname: Katz
authors.forename: Adriano
authors.initials: A
authors.lastname: Caixeta
authors.forename: Márcia R
authors.initials: MR
authors.lastname: Makdisse
authors.forename: Alessandra G
authors.initials: AG
authors.lastname: Correia
authors.forename: Carolina
authors.initials: C
authors.lastname: Pereira
authors.forename: Marcelo
authors.initials: M
authors.lastname: Franken
authors.forename: Anderson N
authors.initials: AN
authors.lastname: Fava
authors.forename: Carlos V
authors.initials: CV
authors.lastname: Serrano
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000378:metabolism; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D009203:Myocardial Infarction / Q000097:blood / Q000401:mortality*; D020097:Natriuretic Peptide, Brain / Q000378:metabolism*; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain