Abstract 15468: Association Between Natriuretic Peptides and Mortality Among Patients Admitted with Myocardial Infarction in the ACTION Registry-GWTG
Background: Patients with higher levels of natriuretic peptides (NP) have poor CV outcomes after myocardial infarction (AMI). The utilization and the prognostic value of NP in large, “real-world” MI cohort has not been evaluated.
Methods: Between July 2007 and Sept 2009, data for 41,683 patients with NSTEMI and 27,860 patients with STEMI were captured at 309 U.S. hospitals for the ACTION Registry-GWTG. NT-proBNP or BNP was measured in 19,528 (46.8%) NSTEMI and 9220 (33.1%) STEMI patients. BNP was the most commonly measured NP (91%).
Results: Patients in whom NP were measured were older and had more comorbidities including prior HF or MI.. Median BNP was higher in NSTEMI vs. STEMI (316 vs 132 pg/ml, respectively). There was a stepwise increase in the adjusted risk of in-hospital mortality with increasing BNP for both NSTEMI and STEMI. (Figure) Risk increased linearly with each 100 pg/ml rise in BNP (adjOR 1.05 for NSTEMI and 1.10 for STEMI) until an absolute level of 2000 and 1000 pg/ml (∼90th% value for NSTEMI and STEMI, respectively), at which point no further incremental risk was seen with even higher levels. The relationship between NP and death was similar in patient with no history of heart failure or shock.
Conclusion: NPs were measured in <50% of patients admitted with MI and appear to be utilized in patients with more comorbidities and higher acuity. NPs were strongly and independently associated with in-hospital mortality in the almost 30,000 patients with NPs measured. More widespread measurement of NP may improve risk stratification of patients with MI beyond baseline clinical variables.
- © 2010 by American Heart Association, Inc.