N-terminal pro-atrial natriuretic peptide (N-ANP) and N-terminal pro-B-type natriuretic peptide (N-BNP) in the prediction of death and heart failure in unselected patients following acute myocardial infarction

Abstract

Elevated plasma natriuretic peptide levels after AMI (acute myocardial infarction) are associated with adverse outcome. The aim of the present study was to examine the relationship of plasma N-ANP (N-terminal pro-atrial natriuretic peptide) and N-BNP (N-terminal pro-B-type natriuretic peptide) with mortality and heart failure following AMI. We studied 403 patients with AMI. Blood was sampled for measurement of N-ANP and N-BNP on a single occasion between 72 and 96 h after symptom onset. Natriuretic peptide levels were related to all-cause mortality and heart failure episodes. During follow up (median, 462 days; range 5-764), 43 (10.7%), 25 (6.2%) and 49 (12.2%) patients suffered death, heart failure hospitalization and outpatient heart failure respectively. Only N-BNP (P < 0.0005), N-ANP (P = 0.005) and previous AMI (P = 0.016) were independently predictive of death. N-BNP, but not N-ANP, predicted 30-day mortality. N-ANP, but not N-BNP, predicted mortality after 30 days. N-BNP was the better predictor of heart failure. N-ANP and N-BNP were above the median in 35 and 38 respectively, of 43 patients who later died. N-ANP, N-BNP, or both were above the median in 41 out of 43 patients. Of 25 patients hospitalized with heart failure, N-ANP and N-BNP was above the median in 20 and 24 respectively, and one or other was elevated in all cases. Above-median N-ANP predicted 36 and N-BNP predicted 41 out of 49 episodes of outpatient heart failure. One or other peptide was above the median in 45 out of 49 patients. Our results indicate that N-BNP predicts 30-day and N-ANP >30-day mortality. We conclude that consideration of both N-ANP and N-BNP identifies a greater number of patients at risk of death or heart failure than either peptide alone.

N-terminal pro-B-type natriuretic peptide complements the GRACE risk score in predicting early and late mortality following acute coronary syndrome

“…the first study comparing GRACE scoring with NT-proBNP both of which have strong prognostic potential [4,5,6,14,15,23,24]. We have shown that there is equivalence of the GRACE risk score and measurement of NT-proBNP levels.…”

“…In parallel with this, biomarkers particularly B type natriuretic peptide (BNP) and its more stable counterpart N-terminal pro-B type natriuretic peptide (NT-proBNP) [9] have been shown to have a vigorous response following an acute myocardial infarction (AMI) [10] and plasma levels are related to short and long-term mortality [11][12][13][14][15]. BNP is able to provide additional prognostic information over and above that provided by left ventricular dysfunction following an acute myocardial infarction [12].…”

C-Terminal Provasopressin (Copeptin) as a Novel and Prognostic Marker in Acute Myocardial Infarction

“…We compared this with NTproBNP, a peptide of established prognostic value benefit in this group of patients. 1,11,12 …”

NT-proANP and NT-proBNP circulating levels as predictors of cardiovascular outcome following coronary stent implantation

“…The close relationship with cardiovascular hemodynamic and structure makes NP levels a very sensitive marker of cardiovascular disease (CVD) risk in the general population [3][4][5][6][7] and a valuable diagnostic and prognostic factor in established CVDs [2]. In fact, the clinical usefulness of NPs appears well established in both stable and unstable coronary atherosclerotic disease, with particular regard to prognostic implications [8][9][10][11][12]. Cardiovascular Revascularization Medicine xxx (2016) xxx-xxx ☆ Conflicts of interest: none declared.…”