Admission B-type natriuretic peptide level predicts long-term survival in low risk ST-elevation myocardial infarction...

In patients with acute myocardial infarction (AMI), B-type natriuretic peptide (BNP) is a predictor of short- and medium-term mortality.

To evaluate the long-term prognostic value of a single measurement of plasma BNP in low risk patients with first ST-elevation myocardial infarction (STEMI).

Plasma BNP concentrations were analysed on admission in 211 patients, median age 68 (56.0-75.0) years, admitted with first STEMI and treated with primary percutaneous coronary intervention (PPCI). Left ventricular ejection fraction (LVEF) was assessed by echocardiography during the first 24 h. Patients were followed for a median 48.2 (42.3-72.6) months.

The median BNP level was 92.5 (36.3-199.2) pg/mL. During the follow-up period, 79.6% of patients survived. Logistic regression analysis indicated that among the assessed clinical, biochemical, angiographic and echocardiographic parameters, the best predictors of mortality were age, LVEF, maximal creatinine concentration and BNP measurements, (p < 0.05). In multivariate Cox regression analysis for the prediction of death, only age remained significant (p = 0.00007). Admission BNP level > 400 pg/mL indicated patients with the highest risk of death (47.1% vs 22% and 18.4% in patients with BNP level < 100 pg/mL and 100-400 pg/mL, respectively; p < 0.05).

A single measurement of BNP on admission can improve long-term risk stratification in low risk first STEMI patients treated with PPCI.