PLASMA BRAIN NATRIURETIC PEPTIDE CONCENTRATIONS PREDICT SURVIVAL AFTER ACUTE MYOCARDIAL-INFARCTION

Objectives. This study sought to examine whether plasma brain natriure tic peptide levels can predict prognosis after myocardial infarction. Background. It has been suggested that concentrations of plasma brain natriuretic peptide reflect left ventricular function. Although the pr ognosis after myocardial infarction depends on residual left ventricul ar function, it is not known whether plasma levels of brain natriureti c peptide after the onset of myocardial infarction can be used to pred ict long-term outcome, Methods. Plasma brain natriuretic peptide and a trial natriuretic peptide levels as weil as invasive hemodynamic varia bles were measured in 70 patients with acute myocardial infarction (53 men, 17 women; mean age 65 years), Measurements were obtained on admi ssion (mean 6 h after onset) and on day 2 after onset. Mean follow-np period was 18 months. Results. Plasma brain natriuretic peptide levels measured on admission and day 2 correlated significantly with hemodyn amic variables, which are influenced by left ventricular function. How ever, plasma atrial natriuretic peptide levels correlated with none of the hemodynamic variables measured on admission; and of those measure d on day 2, plasma atrial natriuretic peptide levels correlated only w ith left atrial filling pressure, During the follow-up period (mean 18 +/- 7 months), 11 patients died of cardiac causes. By Kaplan-Meier an alysis, it was found that patients with plasma brain natriuretic pepti de levels higher than the median level, both on admission and on day 2 , had significantly higher mortality rates than those with the submedi an level (on admission, p < 0.01; on day 2, p < 0.05), However, only t he plasma atrial natriuretic peptide level obtained immediately after admission was significantly related to survival (p < 0.01). By Cox pro portional hazards model analysis of the noninvasive variables, it was found that plasma brain natriuretic peptide concentration was more clo sely related to survival after myocardial infarction (p = 0.0001). Con clusions. Increased plasma brain natriuretic peptide concentrations in the early or subacute phase of myocardial infarction are a powerful n oninvasive indicator of poor prognosis, possibly reflecting residual l eft ventricular function after myocardial infarction.