DIAGNOSTIC-VALUE OF B-TYPE NATRIURETIC PEPTIDE CONCENTRATIONS IN PATIENTS WITH ACUTE MYOCARDIAL-INFARCTION

Although elevations of plasma atrial natriuretic peptide (ANP) concent rations have been shown to have prognostic significance in patients af ter acute myocardial infarction (AMI), the relation between plasma lev els of B-type natriuretic peptide (BNP) and cardiovascular mortality r emains unknown. To test the prognostic value of plasma ANP and BNP aft er AMI, plasma concentrations were measured a mean of 3 days after inf arction in 75 patients. During a median follow-up of 19.7 months, 14 p atients (18.4%) died of cardiovascular causes. On univariate analysis, plasma ANP and BNP, Killip class, modified Peel index, left ventricul ar ejection fraction, and presence of left ventricular failure were al l associated with cardiovascular mortality. In contrast, plasma ANP wa s the only variable that correlated with the development of symptomati c heart failure and hospitalization. For the combined end point of car diovascular mortality, symptomatic heart failure, and hospitalization, plasma neurohormones were the only variables of predictive value. By stepwise regression analysis, plasma BNP was the only significant inde pendent predictor of cardiovascular mortality (p = 0.001), whereas pla sma ANP identified patients at risk of symptomatic heart failure and h ospitalization (p = 0.002 and 0.019, respectively). This study indicat es that plasma BNP measured after AMI is a powerful neurohormonal pred ictor of subsequent cardiovascular mortality, whereas plasma ANP corre lates better with the development of symptomatic heart failure and hos pitalization. Routine measurement of both of these peptides in the per iod immediately after an AMI may provide a simple means of risk strati fication with different information gained from each peptide.