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 PeptideThe 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.
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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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