PROGNOSTIC-SIGNIFICANCE OF N-TERMINAL PROATRIAL NATRIURETIC FACTOR (1-98) IN ACUTE MYOCARDIAL-INFARCTION - COMPARISON WITH ATRIAL-NATRIURETIC-FACTOR (99-126) AND CLINICAL-EVALUATION

Objective-To evaluate the prognostic significance of plasma N-terminal pro-atrial natriuretic factor (1-98) concentrations measured in the s ubacute phase after acute myocardial infarction, and to compare the pr edictive value of measurement of N-terminal pro-atrial natriuretic fac tor (1-98) with the measurement of atrial natriuretic factor (99-126) and with clinical assessment of the degree of heart failure. Design-Pr ospective observational. Setting-Norwegian central hospital. Patients- 139 patients (mean (SD) age 66.9 (11.1) years, 71.2% males) with acute myocardial infarction. Patients in cardiogenic shock or with severe h eart failure (New York Heart Association class IV) were excluded. Main outcome measure-Cardiovascular death within 12 months. Results-During the follow up period 15 patients died. In a univariate Cox proportion al hazards model N-terminal pro-atrial natriuretic factor (1-98) was s ignificantly related to mortality (p = 0.0003). In a multivariate mode l the prognostic value of N-terminal pro-atrial natriuretic factor (1- 98) was better than that of atrial natriuretic factor (99-126) and cli nical assessment of heart failure (N-terminal pro-atrial natriuretic f actor (1-98), p = 0-0003; atrial natriuretic factor (99-126), p = 0.45 13; heart failure, p = 0.0719). The odds ratio estimate of patients in whom plasma concentrations of N-terminal pro-atrial natriuretic facto r (1-98) were greater than 2000 pmol/l was 25 (95% confidence interval 2.8-225.0) compared with patients with plasma concentrations less tha n 1000 pmol/l. Conclusions-These results suggest that determination of plasma N-terminal pro-atrial natriuretic factor (1-98) in the subacut e phase of myocardial infarction may provide clinically relevant progn ostic information that is superior to that obtained from atrial natriu retic factor (99-126) measurements and clinical evaluation.