CLINICAL RESEARCH: BIOMARKERS
Natriuretic peptides as predictors of non-sudden and sudden cardiac death after acute myocardial infarction in the beta-blocking era
Jari M. Tapanainen, MD*,
Kai S. Lindgren, MD*,
Timo H. Mäkikallio, MD*,
Olli Vuolteenaho, MD ,
Juhani Leppäluoto, MD and
Heikki V. Huikuri, MD, FACC*,*
* Division of Cardiology, Department of Internal Medicine, Oulu University Hospital, Oulu, Finland
Department of Physiology, Oulu University, Oulu, Finland
Manuscript received May 22, 2003;
revised manuscript received August 15, 2003,
accepted September 16, 2003.
* Reprint requests and correspondence: Dr. Heikki V. Huikuri, Professor of Medicine, Division of Cardiology, Department of Internal Medicine, Oulu University Hospital, Kajaanintie 50, 90220 Oulu, Finland.
heikki.huikuri{at}oulu.fi
OBJECTIVES: This prospective study tested whether the natriuretic peptides predict cardiac death among patients using beta-blocking therapy after an acute myocardial infarction (AMI).
BACKGROUND: Natriuretic peptides have provided prognostic information after AMI, but their predictive value has not been well established in the era of beta-blocker use.
METHODS: A series of 521 patients (mean age 61 ± 10 years) with AMI was included in the study. The end points were total mortality and non-sudden and sudden cardiac death (SCD). Plasma concentrations of atrial natriuretic peptide (ANP), N-terminal atrial natriuretic propeptide (N-ANP), brain natriuretic peptide (BNP), and ejection fraction (EF) were analyzed before hospital discharge. The cardiac medication was optimized (e.g., adherence to beta-blocking therapy was 97% at discharge and 95% at one year after AMI).
RESULTS: During a mean follow-up of 43 ± 13 months, total mortality was 11.5% (60/521), cardiac mortality was 6.3% (33/521), and 3.1% (16/521) experienced SCD. On univariate analysis, high levels of all measured peptides and low EF predicted the occurrence of non-SCD (p < 0.001 for all). Peptides and EF also predicted the occurrence of SCD (p < 0.05), with elevated BNP (>23.0 pmol/l) being the most powerful predictor (hazard ratio [HR] 4.4, 95% confidence interval [CI] 1.4 to 13.8; p = 0.01). After adjusting for clinical variables, only elevated BNP (HR 3.9, 95% CI 1.2 to 12.3, p = 0.02) and low EF (<40%) (p = 0.03) remained as significant predictors of SCD.
CONCLUSIONS: Natriuretic peptides retain their prognostic value in the beta-blocking era among survivors of AMI. Elevated BNP provides information on the risk of subsequent SCD, independent of clinical variables and left ventricular EF.
|
Abbreviations and Acronyms
| | AMI | = acute myocardial infarction | | ANP | = atrial natriuretic peptide | | BNP | = brain natriuretic peptide | | CI | = confidence interval | | EF | = ejection fraction | | HF | = heart failure | | HR | = hazard ratio | | ICD | = implantable cardioverter-defibrillator | | LV | = left ventricular | | N-ANP | = N-terminal atrial natriuretic propeptide | | SCD | = sudden cardiac death |
|
This article has been cited by other articles:
|
|
|
|
 
L. Ding, W. Hua, H. Niu, K. Chen, and S. Zhang
Primary prevention of sudden cardiac death using implantable cardioverter defibrillators
Europace,
September 1, 2008;
10(9):
1034 - 1041.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. B. Daniels and A. S. Maisel
Natriuretic Peptides
J. Am. Coll. Cardiol.,
December 18, 2007;
50(25):
2357 - 2368.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. V. Exner, K. M. Kavanagh, M. P. Slawnych, L. B. Mitchell, D. Ramadan, S. G. Aggarwal, C. Noullett, A. Van Schaik, R. T. Mitchell, M. A. Shibata, et al.
Noninvasive Risk Assessment Early After a Myocardial Infarction: The REFINE Study
J. Am. Coll. Cardiol.,
December 11, 2007;
50(24):
2275 - 2284.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
W. Jung and B. Schumacher
What is the role of risk stratification for sudden death in the defibrillator era?
Eur. Heart J. Suppl.,
December 1, 2007;
9(suppl_I):
I59 - I65.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. Blangy, N. Sadoul, B. Dousset, A. Radauceanu, R. Fay, E. Aliot, and F. Zannad
Serum BNP, hs-C-reactive protein, procollagen to assess the risk of ventricular tachycardia in ICD recipients after myocardial infarction
Europace,
September 1, 2007;
9(9):
724 - 729.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A Verma, F Kilicaslan, D O Martin, S Minor, R Starling, N F Marrouche, S Almahammed, O M Wazni, S Duggal, R Zuzek, et al.
Preimplantation B-type natriuretic peptide concentration is an independent predictor of future appropriate implantable defibrillator therapies
Heart,
February 1, 2006;
92(2):
190 - 195.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. A. Fallavollita, B. J. Riegel, G. Suzuki, U. Valeti, and J. M. Canty Jr.
Mechanism of sudden cardiac death in pigs with viable chronically dysfunctional myocardium and ischemic cardiomyopathy
Am J Physiol Heart Circ Physiol,
December 1, 2005;
289(6):
H2688 - H2696.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. S. Ginsburg, M. P. Donahue, and L. K. Newby
Prospects for Personalized Cardiovascular Medicine: The Impact of Genomics
J. Am. Coll. Cardiol.,
November 1, 2005;
46(9):
1615 - 1627.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. G. Manios, E. M. Kallergis, E. M. Kanoupakis, H. E. Mavrakis, D. C. Kambouraki, D. A. Arfanakis, and P. E. Vardas
Amino-Terminal Pro-Brain Natriuretic Peptide Predicts Ventricular Arrhythmogenesis in Patients With Ischemic Cardiomyopathy and Implantable Cardioverter-Defibrillators
Chest,
October 1, 2005;
128(4):
2604 - 2610.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. A. Reiffel
Drug and Drug-Device Therapy in Heart Failure Patients in the Post-COMET and SCD-HeFT Era
Journal of Cardiovascular Pharmacology and Therapeutics,
October 1, 2005;
10(4_suppl):
S45 - S58.
[Abstract]
[PDF]
|
|
|
|
|
|
|
A. Gehi, D. Haas, and V. Fuster
Primary Prophylaxis With the Implantable Cardioverter-Defibrillator: The Need for Improved Risk Stratification
JAMA,
August 24, 2005;
294(8):
958 - 960.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Rashidi and D. S. Adler
Brain natriuretic peptide as a predictor of sudden cardiac death in patients with myocardial infarction
J. Am. Coll. Cardiol.,
October 6, 2004;
44(7):
1528 - 1529.
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. V. Huikuri, J. M. Tapanainen, and T. H. Makikallio
Reply
J. Am. Coll. Cardiol.,
October 6, 2004;
44(7):
1529 - 1529.
[Full Text]
[PDF]
|
|
|
|
