Prognostic Value of Natriuretic Peptide Levels and In-Hospital Heart Failure Events in Patients With Acute Myocardial Infarction

Abstract

tion of patients with ST-segment elevation myocardial infarction (STEMI) predicted mortality, 10,11 whereas other reports indicated that NP concentrations during shortterm follow-up after AMI were more predictive than those at baseline. 12,13 In addition, acute HF often develops during hospitalization for AMI, 14 but its prognostic value in combination with NP concentrations is uncertain. 3,15 Thus, the aim of the present study was to evaluate the effects of elevated NP concentrations on admission and at the shortterm follow-up, and in-hospital HF events, individually and in combination, on clinical outcomes after discharge in patients with AMI. Methods Study PopulationThis was a retrospective, observational, bicenter study. [16][17][18][19][20][21] Between January 2012 and March 2020, 1,102 AMI patients I schemic heart disease, such as acute myocardial infarction (AMI), is a major underlying pathogenic factor in heart failure (HF), accounting for approximately 50% of cases in the current era, 1,2 and HF event is a strong predictor of worse outcomes among patients with AMI. 3,4 B-type natriuretic peptide (BNP) and N-terminal pro-BNP (NT-proBNP) are natriuretic peptides (NPs) secreted by the cardiac ventricles in response to end-diastolic pressure and volume, 5 and are widely used as diagnostic biomarkers for HF in clinical practice. 6 Elevated NP concentrations are associated with an increased risk of death and HF in patients with AMI, 5,7 and thus recent guidelines recommend measurement of NPs to gain prognostic information in patients with AMI. 8 However, the trajectory in BNP and NT-proBNP concentrations varies widely among patients, and the appropriate timing for NPs evaluation after AMI remains unclear. 9 For example, early studies demonstrated that the BNP concentration at the time of initial presenta-

Differential Prognostic Impact of Risk-Prediction Models for Heart Failure in Acute Myocardial Infarction: The Original and Revised Heart Failure Time-Points

“…Levels of BNP or NT-proBNP were measured on admission and at short-term follow-up in a real-world setting. The short-term follow-up NP level was obtained immediately before discharge or at the 1-month visit in routine clinical practice at the four institutions [14]. Patients were considered to have HF when NP levels on admission and at short-term follow-up were high, with BNP ≥200 pg/mL or NT-proBNP ≥ 900 pg/mL, according to the guidelines [29].…”

“…The use of intravenous vasodilators such as nitrates and nicorandil did not fulfill the definition of in-hospital HF. The original HFTPs were evaluated using the criteria at the three time-points: on admission, during hospitalization, and at short-term follow-up [14], while the revised HFTPs in the current study were assessed with HF status at the four time-points, including previous HF before admission (Figure 1). When HF was present at each time-point, one point was added to the risk-scoring models.…”

“…In this context, we previously developed a risk-predicting model, namely "HF timepoints (HFTPs)", showing that HF evaluation at different time-points provided diagnostic value for future clinical events in a setting of acute MI [14]. In our previous study, patients with acute MI were assessed as to whether HF was present at three different time-points:…”

“…(1) high NP levels on admission; (2) in-hospital HF events; and (3) high NP levels at shortterm follow-up [15]. With the increase in the number of patients with HF status at the time-points, the rate of all-cause death and HF progressively increased after acute MI [14]. In the original HFTPs, however, a history of HF before admission for MI was not included due to the limited sample size, which also has a prognostic value in patients with acute MI in previous studies [16,17].…”

Icariin improves cardiac function and remodeling via the TGF-β1/Smad signaling pathway in rats following myocardial infarction

“…While modern reperfusion therapy serves as the most efficacious approach for diminishing infarct size and ameliorating clinical outcomes after MI, heart failure remains the primary cause of death subsequent to MI. The process of heart remodeling following MI is acknowledged as the initial phase leading toward heart failure [ 2 , 3 ]. Consequently, the reversal of ventricular remodeling emerges as a highly desirable prospect for the treatment of MI.…”