Association Between Natriuretic Peptides and Mortality Among Patients Admitted With Myocardial Infarction: A Report From the ACTION Registry®-GWTG™

Study Questions:

What is the prognostic impact of natriuretic peptides in patients with myocardial infarction (MI)?

Methods:

The authors examined data from 41,683 patients with non–ST-segment elevation MI (NSTEMI) and 27,860 patients with STEMI at 309 US hospitals, who were enrolled in the ACTION Registry®-GWTG™ (Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With the Guidelines) (AR-G) between July 2008 and September 2009.

Results:

B-type natriuretic peptide (BNP) or N-terminal pro-BNP (NT-proBNP) was measured in 47% of patients with NSTEMI and 33% of patients with STEMI. Patients in whom natriuretic peptides were measured were older and had more comorbidities, including prior heart failure or MI. An increase in in-hospital mortality with increasing BNP quartiles was noted for both NSTEMI (1.3% vs. 3.2% vs. 5.8% vs. 11.1%) and STEMI (1.9% vs. 3.9% vs. 8.2% vs. 17.9%). The addition of BNP improved the discrimination of the AR-G clinical model, with an improvement in the C statistic from 0.796 to 0.807 (p < 0.001) for NSTEMI, and from 0.848 to 0.855 (p = 0.003) for STEMI.

Conclusions:

The authors concluded that among patients with an MI, elevated natriuretic peptides are associated with an exaggerated risk of death.

Perspective:

This study adds to growing evidence supporting an increased risk of death in patients with an elevation in natriuretic peptide levels after an MI. It remains unclear, however, as to how these data can be used to guide therapy. In this registry, natriuretic peptide levels were determined in almost one half of the patients, and future studies are needed to define the clinical utility and the cost-effectiveness of such testing.

Clinical Topics: Anticoagulation Management, Heart Failure and Cardiomyopathies, Acute Heart Failure, Heart Failure and Cardiac Biomarkers

Keywords: Registries, Myocardial Infarction, Hospital Mortality, Heart Failure, Peptide Fragments, Natriuretic Peptide, Brain


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