Author + information
- Received September 17, 2007
- Revision received January 15, 2008
- Accepted January 21, 2008
- Published online May 13, 2008.
- Sohail Q. Khan, MB⁎,⁎ (, )
- Onkar Dhillon, MB⁎,
- Dominic Kelly, MB⁎,
- Iain B. Squire, MD⁎,
- Joachim Struck, PhD†,
- Paulene Quinn, MPhil⁎,
- Nils G. Morgenthaler, MD†,
- Andreas Bergmann, PhD†,
- Joan E. Davies, PhD⁎ and
- Leong L. Ng, MD⁎
- ↵⁎Reprint requests and correspondence:
Dr. Sohail Q. Khan, Department of Cardiovascular Sciences, Clinical Sciences Building, Leicester Royal Infirmary, Leicester, LE2 7LX, United Kingdom.
Objectives Our aim was to assess the prognostic value of midregional proatrial natriuretic peptide (MR-proANP) in patients after acute myocardial infarction (AMI).
Background Multimarker strategies may assist risk stratification after AMI. Midregional proatrial natriuretic peptide is a newly described stable fragment of N-terminal proatrial natriuretic peptide. We compared the prognostic value of MR-proANP and an established marker, N-terminal pro-B-type natriuretic peptide (NT-proBNP), after AMI.
Methods We recruited 983 consecutive post-AMI patients (720 men, median age 65 [range 24 to 95] years) in a prospective study with follow-up over 343 (range 0 to 764) days.
Results Plasma MR-proANP was raised in patients who died (n = 101) compared with that seen in survivors (median 310 [range 48 to 1,150] pmol/l vs. 108 [range 4.9 to 1,210] pmol/l, p < 0.0001). Using Cox modeling, log10MR-proANP (hazard ratio 3.87) and log10NT-proBNP (hazard ratio 3.25) were significant independent predictors of death. In patients stratified by NT-proBNP in the highest quartile (>∼5,900 pmol/l), MR-proANP in the top quartile (∼330 pmol/l) was associated with poorer outcome (p < 0.0001). Findings were similar for heart failure as an individual end point. However, neither marker predicted recurrent AMI.
Conclusions The A- and B-type natriuretic systems are activated after AMI. Midregional proatrial natriuretic peptide is a powerful predictor of adverse outcome, especially in those with an elevated NT-proBNP. Midregional proatrial natriuretic peptide may represent a clinically useful marker of prognosis after an AMI as part of a multimarker strategy targeting the natriuretic neurohormonal pathway.
Dr. Khan was supported by a Junior Fellowship from the British Heart Foundation (FS/03/028/15486). Dr. Ng has submitted patents on behalf of the University of Leicester on biomarkers of cardiac disease. Dr. Bergmann holds ownership in BRAHMS AG, patent rights to the midregional proatrial natriuretic peptide (MR-proANP) assay, and is a member of the board of directors of BRAHMS AG. Dr. Struck holds patent rights to the MR-proANP assay and is an employee of BRAHMS AG. Dr. Morgenthaler is an employee of BRAHMS AG. All authors had full access to the data and take responsibility for its integrity and the accuracy of the analysis. All authors have read and agree to the article as written.
- Received September 17, 2007.
- Revision received January 15, 2008.
- Accepted January 21, 2008.
- American College of Cardiology Foundation