on May 27, 2003
Circulation. 2003
Published online before print May 27, 2003, doi: 10.1161/01.CIR.0000070953.76250.B9
Published online before print May 27, 2003, doi: 10.1161/01.CIR.0000070953.76250.B9
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Submitted on December 31, 2002
From Christchurch Cardioendocrine Research Group, Christchurch School of Medicine and Health Sciences, and Departments Nuclear Medicine (J.T.) and Cardiology (I.G.C.), Christchurch Hospital, Christchurch, New Zealand. * To whom correspondence should be addressed. E-mail: mark.richards{at}cdhb.govt.nz.
Background--A recent landmark report has demonstrated that plasma B-type natriuretic peptide (BNP) measured in acute coronary syndromes independently predicts mortality, heart failure, and new myocardial infarction. After acute cardiac injury, left ventricular ejection fraction (LVEF) is also of prognostic significance and plays a major role in determining the therapeutic response. Methods and Results--The present report is the first from a substantial (n=666) cohort of patients with acute myocardial infarction to test the prognostic utility of concurrent measurements of BNP, amino-terminal BNP (N-BNP), norepinephrine, and radionuclide LVEF. The B-type peptides and LVEF were predictors of death, heart failure, and new myocardial infarction (all P<0.001) independent of patient age, gender, previous myocardial infarction, antecedent hypertension or diabetes, previous heart failure, plasma norepinephrine, creatinine, cholesterol, drug therapy, and coronary revascularization procedures. The combination of N-BNP (or BNP) with LVEF substantially improved risk stratification beyond that provided by either alone. Elevated N-BNP (or BNP) predicted new myocardial infarction only in patients with LVEF <40%. LVEF <40% coupled to N-BNP over the group median conferred substantial 3-year risks of death, heart failure, and new myocardial infarction of 37%, 18%, and 26%, respectively. N-BNP and BNP were equivalent prognostic markers for these clinical outcomes. Conclusions--Plasma N-BNP (or BNP) and LVEF are complementary independent predictors of major adverse events on follow-up after myocardial infarction. Combined measurement provides risk stratification substantially better than that provided by either alone.
Revised on March 14, 2003
Accepted on March 17, 2003
B-Type Natriuretic Peptides and Ejection Fraction for Prognosis After Myocardial Infarction
A. Mark Richards MD, PhD*,
Key words: coronary disease • natriuretic peptides • heart failure
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