Prognostic value of N-terminal proatrial natriuretic factor plasma levels measured within the first 12 hours after myocardial infarction. Thrombolysis in Myocardial Infarction (TIMI) II Investigators

University of Oslo, Norway.

OBJECTIVES: The aim of the present study was to examine the relation between the plasma levels of the atrial peptide N-terminal proatrial natriuretic factor (proANF) measured during the 1st 12 h after myocardial infarction and 1-year mortality. BACKGROUND: The atrial peptides atrial natriuretic factor and N-terminal proANF are released from cardiac atria secondary to increased atrial pressures. The plasma levels of both peptides have been found to be related to long-term prognosis when measured in the subacute phase of myocardial infarction. METHODS: The study was of a retrospective case-control design studying patients enrolled in the Thrombolysis in Myocardial Infarction (TIMI) II trial. Seventy-six patients who died within the 1st year of enrollment in the trial were matched with another 76 patients who survived. N-terminal proANF was analyzed by radioimmunoassay at enrollment (no later than 4 h after the start of chest pain) and at 50 min, 5 h and 8 h after enrollment. RESULTS: At all studied time points the peptide levels were significantly higher in the case group than in the control group. At 8 h after enrollment, an N-terminal proANF value above a cutoff point of 1,500 pmol/liter was associated with an odds ratio for death of 3.9. CONCLUSIONS: The plasma level of N-terminal proANF, when measured during the 1st 12 h after the onset of chest pain, is related to 1-year mortality after myocardial infarction. Together with previous findings, these results suggest that N-terminal proANF measurements represent a valuable supplement to currently used prognostic indicators after myocardial infarction.

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