This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (11) Citing Articles via Google Scholar Google Scholar Articles by Khan, S. Q. Articles by Ng, L. L. Search for Related Content PubMed PubMed Citation Articles by Khan, S. Q. Articles by Ng, L. L. Related Collections Related Article

CLINICAL RESEARCH: MYOCARDIAL INFARCTION

Plasma N-Terminal B-Type Natriuretic Peptide as an Indicator of Long-Term Survival After Acute Myocardial Infarction: Comparison With Plasma Midregional Pro-Atrial Natriuretic Peptide

The LAMP (Leicester Acute Myocardial Infarction Peptide) Study

Sohail Q. Khan, MB^_*,_*, Onkar Dhillon, MB^_*, Dominic Kelly, MB^_*, Iain B. Squire, MD^_*, Joachim Struck, PhD, Paulene Quinn, MPhil^_*, Nils G. Morgenthaler, MD, Andreas Bergmann, PhD, Joan E. Davies, PhD^_* and Leong L. Ng, MD^_*

^_* University of Leicester, Department of Cardiovascular Sciences, Clinical Sciences Building, Leicester Royal Infirmary, Leicester, United Kingdom
Research Department, BRAHMS Aktiengesellschaft, Hennigsdorf, Germany.

Manuscript received September 17, 2007; revised manuscript received January 15, 2008, accepted January 21, 2008.

^_* Reprint requests and correspondence: Dr. Sohail Q. Khan, Department of Cardiovascular Sciences, Clinical Sciences Building, Leicester Royal Infirmary, Leicester, LE2 7LX, United Kingdom. (Email: sqk1{at}le.ac.uk).

Objectives: Our aim was to assess the prognostic value of midregional proatrial natriuretic peptide (MR-proANP) in patients after acute myocardial infarction (AMI).

Background: Multimarker strategies may assist risk stratification after AMI. Midregional proatrial natriuretic peptide is a newly described stable fragment of N-terminal proatrial natriuretic peptide. We compared the prognostic value of MR-proANP and an established marker, N-terminal pro-B-type natriuretic peptide (NT-proBNP), after AMI.

Methods: We recruited 983 consecutive post-AMI patients (720 men, median age 65 [range 24 to 95] years) in a prospective study with follow-up over 343 (range 0 to 764) days.

Results: Plasma MR-proANP was raised in patients who died (n = 101) compared with that seen in survivors (median 310 [range 48 to 1,150] pmol/l vs. 108 [range 4.9 to 1,210] pmol/l, p < 0.0001). Using Cox modeling, log₁₀MR-proANP (hazard ratio 3.87) and log₁₀NT-proBNP (hazard ratio 3.25) were significant independent predictors of death. In patients stratified by NT-proBNP in the highest quartile (>5,900 pmol/l), MR-proANP in the top quartile (330 pmol/l) was associated with poorer outcome (p < 0.0001). Findings were similar for heart failure as an individual end point. However, neither marker predicted recurrent AMI.

Conclusions: The A- and B-type natriuretic systems are activated after AMI. Midregional proatrial natriuretic peptide is a powerful predictor of adverse outcome, especially in those with an elevated NT-proBNP. Midregional proatrial natriuretic peptide may represent a clinically useful marker of prognosis after an AMI as part of a multimarker strategy targeting the natriuretic neurohormonal pathway.

Abbreviations and Acronyms   AMI = acute myocardial infarction   ANP = atrial natriuretic peptide   AUC = area under the curve(s)   BNP = B-type natriuretic peptide   CI = confidence interval   CV = coefficient of variation   eGFR = estimated glomerular filtration rate   HF = heart failure   HR = hazard ratio   MI = myocardial infarction   MR-proANP = midregional proatrial natriuretic peptide   NSTEMI = non–ST-segment elevation myocardial infarction   NT-proBNP = N-terminal pro-B-type natriuretic peptide   STEMI = ST-segment elevation myocardial infarction

Related Article

Inside This Issue of JACC
J. Am. Coll. Cardiol. 2008 51: A35-A36. [Full Text] [PDF]

This article has been cited by other articles:

				K. J. J. van Hateren, A. Alkhalaf, N. Kleefstra, K. H. Groenier, P. E. de Jong, D. de Zeeuw, R. O. B. Gans, J. Struck, H. J. G. Bilo, R. T. Gansevoort, et al. Comparison of Midregional Pro-A-Type Natriuretic Peptide and the N-Terminal Pro-B-Type Natriuretic Peptide for Predicting Mortality and Cardiovascular Events Clin. Chem., January 1, 2012; 58(1): 293 - 297. [Abstract] [Full Text] [PDF]

				C. D. Steadman, S. Ray, L. L. Ng, and G. P. McCann Natriuretic Peptides in Common Valvular Heart Disease J. Am. Coll. Cardiol., May 11, 2010; 55(19): 2034 - 2048. [Abstract] [Full Text] [PDF]

				A. Maisel, C. Mueller, R. Nowak, W. F. Peacock, J. W. Landsberg, P. Ponikowski, M. Mockel, C. Hogan, A. H. B. Wu, M. Richards, et al. Mid-Region Pro-Hormone Markers for Diagnosis and Prognosis in Acute Dyspnea: Results From the BACH (Biomarkers in Acute Heart Failure) Trial J. Am. Coll. Cardiol., May 11, 2010; 55(19): 2062 - 2076. [Abstract] [Full Text] [PDF]

				Q. A. Truong, E. Siegel, M. Karakas, J. L. Januzzi Jr., F. Bamberg, A. A. Mahabadi, S. Dasdemir, T. J. Brady, A. Bergmann, J. Kunde, et al. Relation of Natriuretic Peptides and Midregional Proadrenomedullin to Cardiac Chamber Volumes by Computed Tomography in Patients without Heart Failure: From the ROMICAT Trial Clin. Chem., April 1, 2010; 56(4): 651 - 660. [Abstract] [Full Text] [PDF]

				C. Maier, M. Clodi, S. Neuhold, M. Resl, M. Elhenicky, R. Prager, D. Moertl, G. Strunk, A. Luger, J. Struck, et al. Endothelial Markers May Link Kidney Function to Cardiovascular Events in Type 2 Diabetes Diabetes Care, October 1, 2009; 32(10): 1890 - 1895. [Abstract] [Full Text] [PDF]

				G. Engstrom, O. Melander, and B. Hedblad Carotid Intima-Media Thickness, Systemic Inflammation, and Incidence of Heart Failure Hospitalizations Arterioscler Thromb Vasc Biol, October 1, 2009; 29(10): 1691 - 1695. [Abstract] [Full Text] [PDF]

				O. Melander, C. Newton-Cheh, P. Almgren, B. Hedblad, G. Berglund, G. Engstrom, M. Persson, J. G. Smith, M. Magnusson, A. Christensson, et al. Novel and Conventional Biomarkers for Prediction of Incident Cardiovascular Events in the Community JAMA, July 1, 2009; 302(1): 49 - 57. [Abstract] [Full Text] [PDF]

				M. Pfisterer, P. Buser, H. Rickli, M. Gutmann, P. Erne, P. Rickenbacher, A. Vuillomenet, U. Jeker, P. Dubach, H. Beer, et al. BNP-Guided vs Symptom-Guided Heart Failure Therapy: The Trial of Intensified vs Standard Medical Therapy in Elderly Patients With Congestive Heart Failure (TIME-CHF) Randomized Trial JAMA, January 28, 2009; 301(4): 383 - 392. [Abstract] [Full Text] [PDF]