Prognostic significance of N-terminal pro-atrial natriuretic factor (1-98) in acute myocardial infarction: Comparison with atrial natriuretic factor (99-126) and clinical evaluation

Abstract

Objective-To evaluate the prognostic significance of plasma N-terminal proatrial natriuretic factor (1-98) concentrations measured in the subacute phase after acute myocardial infarction, and to compare the predictive value of measurement of N-terminal pro-atrial natriuretic factor (1-98) with the measurement of atrial natriuretic factor (99-126) and with clinical assessment of the degree of heart failure. Design-Prospective 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 heart 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 proportional hazards model N-terminal pro-atrial natriuretic factor (1-98) was significantly related to mortality (p = 0·0003). In a multivariate model the prognostic value of N-terminal pro-atrial natriuretic factor (1-98) was better than that of atrial natriuretic factor (99-126) and clinical assessment of heart failure (N-terminal pro-atrial natriuretic factor (1-98), p = 0·0003; atrial natriuretic factor (99-126), p = 0·4513; heart failure, p = 0·0719). The odds ratio estimate of patients in whom plasma concentrations of N-terminal pro-atrial natriuretic factor (1-98) were greater than 2000 pmol/l was 25 (95% confidence interval 2·8-225·0) compared with patients with plasma concentrations less than 1000 pmol/l. Conclusions-These results suggest that determination of plasma N-terminal proatrial natriuretic factor (1-98) in the subacute phase of myocardial infarction may provide clinically relevant prognostic information that is superior to that obtained from atrial natriuretic factor (99-126) measurements and clinical evaluation.