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J Am Coll Cardiol, 2008; 51:1857-1864, doi:10.1016/j.jacc.2008.01.041
© 2008 by the American College of Cardiology Foundation
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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{dagger}, Paulene Quinn, MPhil*, Nils G. Morgenthaler, MD{dagger}, Andreas Bergmann, PhD{dagger}, 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
{dagger} 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


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JACC 2008 51: 35-36. [Full Text]  






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