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(Circulation. 2004;110:1387-1391.)
© 2004 American Heart Association, Inc.

Original Articles

Plasma Level of B-Type Natriuretic Peptide as a Prognostic Marker After Acute Myocardial Infarction

A Long-Term Follow-Up Analysis

Satoru Suzuki, MD; Michihiro Yoshimura, MD; Masafumi Nakayama, MD; Yuji Mizuno, MD; Eisaku Harada, MD; Teruhiko Ito, MD; Shota Nakamura, MD; Koji Abe, MD; Megumi Yamamuro, MD; Tomohiro Sakamoto, MD; Yoshihiko Saito, MD; Kazuwa Nakao, MD; Hirofumi Yasue, MD; Hisao Ogawa, MD

From the Department of Cardiovascular Medicine (S.S., M. Yoshimura, M.N., S.N., K.A., M. Yamamuro, T.S., H.O.), Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan; Division of Cardiology (Y.M., E.H., T.I., H.Y.), Kumamoto Aging Research Institute, Kumamoto, Japan; First Department of Internal Medicine (Y.S.), Nara Medical University, Nara, Japan; and Department of Medicine and Clinical Science (K.N.), Kyoto University Graduate School of Medicine, Kyoto, Japan.

Reprint requests to Michihiro Yoshimura, Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan. E-mail bnp{at}kumamoto-u.ac.jp

Received January 16, 2004; de novo received March 30, 2004; revision received May 4, 2004; accepted May 6, 2004.

Background— Circulating levels of B-type natriuretic peptide (BNP), a cardiac hormone, reflect the severity of cardiac dysfunction. Because the plasma BNP level changes dramatically during the period after the onset of acute myocardial infarction (AMI), identification of a suitable sampling time is problematic. There have been several reports indicating that the plasma BNP level obtained in the acute phase of AMI can be used as a prognostic marker. We examined whether the plasma BNP level measured 3 to 4 weeks after the onset of AMI represents a reliable prognostic marker for patients with AMI.

Methods and Results— We analyzed 145 consecutive patients with AMI. Plasma BNP levels were measured during the 3 to 4 weeks after onset of AMI. Of those patients, 23 experienced fatal cardiac events during this study. The mean follow-up period was 58.6 months. Log BNP, left ventricular end-diastolic pressure, and pulmonary vascular resistance were all significantly higher in the cardiac death group, and there were more men and more patients with a history of heart failure in the cardiac death group. A Cox proportional hazards model analysis showed that log BNP was an independent predictor of cardiac death. The survival rate was significantly higher in patients with log BNP <2.26 (180 pg/mL) than in those with log BNP 2.26.

Conclusions— The plasma BNP level obtained 3 to 4 weeks after the onset of AMI can be used as an independent predictor of cardiac death in patients with AMI.

Key Words: natriuretic peptides • myocardial infarction • prognosis

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