Abstract
The TIMI 11B trial was sponsored by Aventis, Bridgewater, New Jersey. Circulating concentrations of the cardiac natriuretic peptides, atrial natriuretic peptide (ANP), and brain (B-type) natriuretic peptide (BNP), and the N-terminal fragments of their prohormones, N-terminal pro-atrial natriuretic peptide (Nt-proANP) and N-terminal pro-brain natriuretic peptide (Nt-proBNP), are related to long-term survival after acute myocardial infarction (AMI), independent of conventional risk markers.1–5 Because previous studies have included predominantly patients with ST-segment elevation AMI, sparse information exists regarding the cardiac natriuretic peptide system in patients with non–ST-segment elevation acute coronary syndromes (unstable angina and/or non–ST-segment elevation AMI). Furthermore, data integrating prognostic information obtained from natriuretic peptide determination with that obtained from cardiac-specific troponins and electrocardiographic variables in acute coronary syndromes are limited. Cross-sectional data from small cohorts of patients have suggested that circulating BNP and Nt-proBNP, but not ANP levels, are higher in patients with unstable angina than in patients with stable coronary artery disease.6,7 In 1 study, BNP levels were increased only in patients with echocardiographic evidence of regional wall motion abnormalities,6 suggesting that BNP production may increase in proportion to coronary artery disease severity and the extent of myocardium at risk. We hypothesized that circulating levels of cardiac natriuretic peptides would be predictive of subsequent death and/or nonfatal AMI in patients with non–ST-segment elevation acute coronary syndromes, and might offer prognostic information independent of cardiac-specific troponins. Because previous studies have suggested that the prognostic value of the N-terminal fragments of their respective prohormones may be superior to that of ANP and BNP,1,2,5 we measured Nt-proANP and Nt-proBNP in the present study.
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