Predictive Value of Repeated Versus Single N-Terminal Pro B-Type Natriuretic Peptide Measurements Early After-Myocardial Infarction

Background: A single, markedly elevated B‐type natriuretic peptide (BNP) serum concentration predicts an increased risk of death after myocardial infarction (MI), though its sensitivity and predictive accuracy are low. We compared the predictive value of a modestly and persistently elevated, versus a single, markedly elevated measurement of N terminal pro‐BNP (NT‐BNP) early after MI. Methods and Results: NT‐BNP was measured 2–4, 6–10, and 14–18 weeks after MI. The median age of the 100 patients was 61 years, median left ventricular ejection fraction (LVEF) was 0.40, and 88% were males. Over a median follow‐up of 39 months, 10 patients died. The initial median NT‐BNP was 802 pg/mL and declined over time (P = 0.002). An initial NT‐BNP ≥2,300 pg/mL (upper quintile) was observed in 19 patients and predicted a 3.4‐fold higher independent risk of death (P = 0.05), with modest sensitivity (30%) and positive predictive accuracy (16%). A NT‐BNP consistently ≥1,200 pg/mL (upper tertile) was observed in 19 patients, and was associated with a 5.7‐fold higher independent risk of death (P = 0.01), with a higher sensitivity (50%) and positive predictive accuracy (26%) than a single, markedly elevated NT‐BNP measurement. Conclusions: A moderately and persistently elevated NT‐BNP in the early post‐MI period was associated with a 5.7‐fold higher risk of death, independent of age, LVEF, and functional class. Compared with a single measurement, serial NT‐BNP measurements early after MI were more accurate predictors of risk of death.