Prognostic Value Of Serial N Terminal-Pro Brain Natriuretic Peptide Testing In Patients With Acute Myocardial Infarction

摘要

Natriuretic peptides (NP) are important predictors of outcomes in patients with acute myocardial infarction (AMI), but can change over time. The association of patterns of NP changes after AMI is less clear. We measured N terminal pro brain natriuretic peptide (NT-proBNP) during the AMI admission and at 1 month in a prospective AMI registry. Outcomes included 6 month dyspnea scores, 1-year readmission and 2-year mortality. An elevated NT-proBNP was defined using age-specific criteria. Patients were classified into 4 groups (Low/Low (referent group), Low/High, High/Low, High/High) based on NT-proBNP value at enrollment and 1 month. The incremental predictive value of NT-proBNP was determined after adjusting for 6-month GRACE risk score, diabetes and ejection fraction<40%. Among 803 patients, 303 (38%) were Low/Low, 240 (30%), were High/High, 230 (29%) were High/Low, and 30 (3.7%) were Low/High. Two-year mortality was highest in High/High patients but similar in the High/Low and Low/Low patients (13.1% vs 2.7% and 2.3%, respectively). Similarly, hospital readmission was significantly more likely in the High/High vs the High/Low and Low/Low groups (44.7% vs 19.8% and 22.3%, respectively). After adjustment, mortality was significantly higher in the High/High group (HR 4.02, 95% CI 1.67, 9.66) compared to the Low/Low group, although readmission was no longer different (HR 1.37, 95% CI 0.93, 2.03). In conclusion, persistently elevated NT-proBNP assessed 1 month after discharge was associated with a higher risk of mortality among AMI patients, whereas those in which NT-proBNP improved had similar outcomes as those with persistently low NT-proBNP. Post-discharge risk stratification using NT-proBNP has the potential to identify higher-risk patients after AMI.