NEUROHUMORAL MEASUREMENTS AS INDICATORS OF LONG-TERM PROGNOSIS AFTER ACUTE MYOCARDIAL-INFARCTION

The objective of this study was to evaluate the prognostic accuracy an d usefulness of neurohumoral determination as a risk stratification to ol after acute myocardial infarction (AMI) by comparing the long-term prognostic value of subacute neurohumoral measurements with other esta blished indicators of adverse outcome. The study included 145 patients with documented AMI, During a median follow-vp of 3.7 years, 30 cardi ovascular and 6 noncardiovascular deaths occurred, By univariate analy sis, plasma atrial natriuretic factor (ANF) and endothelin levels were strongly related to long-term cardiovascular mortality. In multivaria te models, both peptides added prognostic information to that obtained from clinical evaluation, but not to that obtained from left ventricu lar election fraction (LVEF). Estimation of the area under the receive r-operating characteristic curve showed comparable prognostic accuracy for LVEF (0.7788), plasma ANF (0.7795), plasma endothelin (0.7493), a nd Killip classification (0.8203), meaning that for all these prognost ic indicators, a randomly selected patient from the group of patients dying will have a test value larger than that of a randomly selected p atient from the group of surviving patients 75% to 82% of the time, Th e clinical usefulness of neurohumoral determination in routine risk st ratification after AMI appears to be limited since no additional progn ostic information to that provided by objective evaluation of LV systo lic function is obtained, However, in patients for whom objective asse ssment of LV performance is not readily available, measurement of plas ma ANF and endothelin may be helpful in identifying asymptomatic patie nts at risk for cardiac death.