Prognostic Value of Serial N-Terminal Pro-Brain Natriuretic Peptide Testing in Patients With Acute Myocardial Infarction
Natriuretic peptides (NPs) are important predictors of outcomes in patients with acute myocardial infarction (AMI) but can change over time. The association of patterns of NP changes after AMI on outcomes is less clear. We measured N-terminal pro-brain natriuretic peptide (NT-proBNP) during the AMI...
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| Veröffentlicht in: | The American journal of cardiology 2017-07, Vol.120 (2), p.181-185 |
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| creator | Kontos, Michael C., MD Lanfear, David E., MD Gosch, Kensey, MS Daugherty, Stacie L., MD Heidenriech, Paul, MD Spertus, John A., MD |
| description | Natriuretic peptides (NPs) are important predictors of outcomes in patients with acute myocardial infarction (AMI) but can change over time. The association of patterns of NP changes after AMI on outcomes is less clear. We measured N-terminal pro-brain natriuretic peptide (NT-proBNP) during the AMI admission and at 1 month in a prospective AMI registry. Outcomes included 1-year readmission and 2-year mortality. An elevated NT-proBNP was defined using age-specific criteria. Patients were classified into 3 groups (low/low [referent group], high/low, high/high) based on NT-proBNP value at enrollment and 1 month. The incremental predictive value of NT-proBNP was determined after adjusting for 6-month GRACE risk score, diabetes, and ejection fraction |
| doi_str_mv | 10.1016/j.amjcard.2017.04.004 |
| format | Article |
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The association of patterns of NP changes after AMI on outcomes is less clear. We measured N-terminal pro-brain natriuretic peptide (NT-proBNP) during the AMI admission and at 1 month in a prospective AMI registry. Outcomes included 1-year readmission and 2-year mortality. An elevated NT-proBNP was defined using age-specific criteria. Patients were classified into 3 groups (low/low [referent group], high/low, high/high) based on NT-proBNP value at enrollment and 1 month. The incremental predictive value of NT-proBNP was determined after adjusting for 6-month GRACE risk score, diabetes, and ejection fraction <40%. Among 773 patients, 303 (38%) were low/low, 240 (30%), and were high/high, 230 (29%) were high/low. Two-year mortality was highest in high/high patients but similar in the high/low and low/low patients (13.1% vs 2.7% and 2.3%, respectively). Similarly, readmission was significantly more likely in the high/high versus the high/low and low/low groups. After adjustment, mortality was significantly higher in the high/high group (hazard ratio 4.02, 95% CI 1.67 to 9.66) compared with the low/low group, although readmission was no longer statistically different (hazard ratio 1.37, 95% CI 0.93 to 2.03). In conclusion, a persistently elevated NT-proBNP assessed 1 month after discharge was associated with a higher risk of mortality in patient with AMI. Postdischarge risk stratification using NT-proBNP has the potential to identify higher risk patients after AMI.</description><identifier>ISSN: 0002-9149</identifier><identifier>EISSN: 1879-1913</identifier><identifier>DOI: 10.1016/j.amjcard.2017.04.004</identifier><identifier>PMID: 28599802</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Age ; Biomarkers - blood ; Brain ; Brain natriuretic peptide ; Cardiovascular ; Diabetes mellitus ; Female ; Follow-Up Studies ; Health risk assessment ; Health risks ; Heart attacks ; Humans ; Laboratories ; Male ; Medical prognosis ; Middle Aged ; Mortality ; Myocardial infarction ; Myocardial Infarction - blood ; Myocardial Infarction - mortality ; Natriuretic Peptide, Brain - blood ; Patient Readmission - trends ; Patients ; Peptide Fragments - blood ; Peptides ; Prognosis ; Prospective Studies ; Registries ; Risk ; Risk Assessment ; Survival Rate - trends ; Time Factors ; United States - epidemiology</subject><ispartof>The American journal of cardiology, 2017-07, Vol.120 (2), p.181-185</ispartof><rights>Elsevier Inc.</rights><rights>2017 Elsevier Inc.</rights><rights>Copyright © 2017 Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited Jul 15, 2017</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c550t-7db7a683744e50bfac47c8dfd5422f60603d1086b0be90f1b7b801eb19aa9d743</citedby><cites>FETCH-LOGICAL-c550t-7db7a683744e50bfac47c8dfd5422f60603d1086b0be90f1b7b801eb19aa9d743</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0002914917306926$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,776,780,881,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28599802$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kontos, Michael C., MD</creatorcontrib><creatorcontrib>Lanfear, David E., MD</creatorcontrib><creatorcontrib>Gosch, Kensey, MS</creatorcontrib><creatorcontrib>Daugherty, Stacie L., MD</creatorcontrib><creatorcontrib>Heidenriech, Paul, MD</creatorcontrib><creatorcontrib>Spertus, John A., MD</creatorcontrib><title>Prognostic Value of Serial N-Terminal Pro-Brain Natriuretic Peptide Testing in Patients With Acute Myocardial Infarction</title><title>The American journal of cardiology</title><addtitle>Am J Cardiol</addtitle><description>Natriuretic peptides (NPs) are important predictors of outcomes in patients with acute myocardial infarction (AMI) but can change over time. The association of patterns of NP changes after AMI on outcomes is less clear. We measured N-terminal pro-brain natriuretic peptide (NT-proBNP) during the AMI admission and at 1 month in a prospective AMI registry. Outcomes included 1-year readmission and 2-year mortality. An elevated NT-proBNP was defined using age-specific criteria. Patients were classified into 3 groups (low/low [referent group], high/low, high/high) based on NT-proBNP value at enrollment and 1 month. The incremental predictive value of NT-proBNP was determined after adjusting for 6-month GRACE risk score, diabetes, and ejection fraction <40%. Among 773 patients, 303 (38%) were low/low, 240 (30%), and were high/high, 230 (29%) were high/low. Two-year mortality was highest in high/high patients but similar in the high/low and low/low patients (13.1% vs 2.7% and 2.3%, respectively). Similarly, readmission was significantly more likely in the high/high versus the high/low and low/low groups. After adjustment, mortality was significantly higher in the high/high group (hazard ratio 4.02, 95% CI 1.67 to 9.66) compared with the low/low group, although readmission was no longer statistically different (hazard ratio 1.37, 95% CI 0.93 to 2.03). In conclusion, a persistently elevated NT-proBNP assessed 1 month after discharge was associated with a higher risk of mortality in patient with AMI. Postdischarge risk stratification using NT-proBNP has the potential to identify higher risk patients after AMI.</description><subject>Age</subject><subject>Biomarkers - blood</subject><subject>Brain</subject><subject>Brain natriuretic peptide</subject><subject>Cardiovascular</subject><subject>Diabetes mellitus</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Health risk assessment</subject><subject>Health risks</subject><subject>Heart attacks</subject><subject>Humans</subject><subject>Laboratories</subject><subject>Male</subject><subject>Medical prognosis</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Myocardial infarction</subject><subject>Myocardial Infarction - blood</subject><subject>Myocardial Infarction - mortality</subject><subject>Natriuretic Peptide, Brain - blood</subject><subject>Patient Readmission - trends</subject><subject>Patients</subject><subject>Peptide Fragments - blood</subject><subject>Peptides</subject><subject>Prognosis</subject><subject>Prospective Studies</subject><subject>Registries</subject><subject>Risk</subject><subject>Risk Assessment</subject><subject>Survival Rate - trends</subject><subject>Time Factors</subject><subject>United States - epidemiology</subject><issn>0002-9149</issn><issn>1879-1913</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFUk1v1DAQjRCIbgs_ARSJC5eEmcRJ7EtRqfioVMpKXeBoOc5k65CNFzupuv8eR7sU6IWTbc17z2_mTRS9QEgRsHzTpWrTaeWaNAOsUmApAHsULZBXIkGB-eNoAQBZIpCJo-jY-y48EYvyaXSU8UIIDtkiuls6ux6sH42Ov6l-oti28TU5o_r4KlmR25ghXAMqeeeUGeIrNTozOZoJS9qOpqF4RYE_rONQXqrR0DD6-LsZb-IzPY0Uf97Z2egseTG0yunR2OFZ9KRVvafnh_Mk-vrh_er8U3L55ePF-dlloosCxqRq6kqVPK8YowLqVmlWad60TcGyrC2hhLxB4GUNNQlosa5qDkg1CqVEU7H8JDrd626nekONDuac6uXWmY1yO2mVkf9WBnMj1_ZWFjxDlhdB4PVBwNmfU-hUbozX1PdqIDt5iQI4yyGvMEBfPYB2dnJhfjMKETkLrgOq2KO0s947au_NIMg5W9nJQ7ZyzlYCkyHbwHv5dyf3rN9hBsDbPYDCPG8NOel1CENTYxzpUTbW_PeL0wcKujeD0ar_QTvyf7qRPpMgr-cFm_cLqxxKkZX5L8htzjg</recordid><startdate>20170715</startdate><enddate>20170715</enddate><creator>Kontos, Michael C., MD</creator><creator>Lanfear, David E., MD</creator><creator>Gosch, Kensey, MS</creator><creator>Daugherty, Stacie L., MD</creator><creator>Heidenriech, Paul, MD</creator><creator>Spertus, John A., MD</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>M7Z</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20170715</creationdate><title>Prognostic Value of Serial N-Terminal Pro-Brain Natriuretic Peptide Testing in Patients With Acute Myocardial Infarction</title><author>Kontos, Michael C., MD ; Lanfear, David E., MD ; Gosch, Kensey, MS ; Daugherty, Stacie L., MD ; Heidenriech, Paul, MD ; Spertus, John A., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c550t-7db7a683744e50bfac47c8dfd5422f60603d1086b0be90f1b7b801eb19aa9d743</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Age</topic><topic>Biomarkers - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>The American journal of cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kontos, Michael C., MD</au><au>Lanfear, David E., MD</au><au>Gosch, Kensey, MS</au><au>Daugherty, Stacie L., MD</au><au>Heidenriech, Paul, MD</au><au>Spertus, John A., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prognostic Value of Serial N-Terminal Pro-Brain Natriuretic Peptide Testing in Patients With Acute Myocardial Infarction</atitle><jtitle>The American journal of cardiology</jtitle><addtitle>Am J Cardiol</addtitle><date>2017-07-15</date><risdate>2017</risdate><volume>120</volume><issue>2</issue><spage>181</spage><epage>185</epage><pages>181-185</pages><issn>0002-9149</issn><eissn>1879-1913</eissn><abstract>Natriuretic peptides (NPs) are important predictors of outcomes in patients with acute myocardial infarction (AMI) but can change over time. The association of patterns of NP changes after AMI on outcomes is less clear. We measured N-terminal pro-brain natriuretic peptide (NT-proBNP) during the AMI admission and at 1 month in a prospective AMI registry. Outcomes included 1-year readmission and 2-year mortality. An elevated NT-proBNP was defined using age-specific criteria. Patients were classified into 3 groups (low/low [referent group], high/low, high/high) based on NT-proBNP value at enrollment and 1 month. The incremental predictive value of NT-proBNP was determined after adjusting for 6-month GRACE risk score, diabetes, and ejection fraction <40%. Among 773 patients, 303 (38%) were low/low, 240 (30%), and were high/high, 230 (29%) were high/low. Two-year mortality was highest in high/high patients but similar in the high/low and low/low patients (13.1% vs 2.7% and 2.3%, respectively). Similarly, readmission was significantly more likely in the high/high versus the high/low and low/low groups. After adjustment, mortality was significantly higher in the high/high group (hazard ratio 4.02, 95% CI 1.67 to 9.66) compared with the low/low group, although readmission was no longer statistically different (hazard ratio 1.37, 95% CI 0.93 to 2.03). In conclusion, a persistently elevated NT-proBNP assessed 1 month after discharge was associated with a higher risk of mortality in patient with AMI. Postdischarge risk stratification using NT-proBNP has the potential to identify higher risk patients after AMI.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>28599802</pmid><doi>10.1016/j.amjcard.2017.04.004</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Age Biomarkers - blood Brain Brain natriuretic peptide Cardiovascular Diabetes mellitus Female Follow-Up Studies Health risk assessment Health risks Heart attacks Humans Laboratories Male Medical prognosis Middle Aged Mortality Myocardial infarction Myocardial Infarction - blood Myocardial Infarction - mortality Natriuretic Peptide, Brain - blood Patient Readmission - trends Patients Peptide Fragments - blood Peptides Prognosis Prospective Studies Registries Risk Risk Assessment Survival Rate - trends Time Factors United States - epidemiology |
| title | Prognostic Value of Serial N-Terminal Pro-Brain Natriuretic Peptide Testing in Patients With Acute Myocardial Infarction |
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