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 pro-atrial 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 pro-atrial 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.

• Authors: T Omland, V V Bonarjee, D W Nilsen, J A Sundsfjord, R T Lie, G Thibault, K Dickstein
• Journal: British heart journal (Br Heart J) Vol. 70 Issue 5 Pg. 409-14 (Nov 1993) ISSN: 0007-0769 [Print] England
• PMID: 8260270 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Peptide Fragments
• Protein Precursors
• atrial natriuretic factor prohormone (1-98)
• Atrial Natriuretic Factor

Topics

• Aged
• Atrial Natriuretic Factor (blood)
• Female
• Humans
• Male
• Myocardial Infarction (blood, mortality)
• Peptide Fragments (blood)
• Predictive Value of Tests
• Prognosis
• Proportional Hazards Models
• Prospective Studies
• Protein Precursors (blood)