Background: Plasma natriuretic peptide levels provide information on ventricular function and prognosis after acute MI(AMI). We assessed the prognostic value of plasma natriuretic peptide levels at various time points after AMI.

Methods: BNP, N-BNP, N-ANP and CNP values were acquired at randomisation (median three days), after one month, 1 year and 2 years in 236 patients in the neurohomonal substudy of the OPTIMAAL trial (patients >55 years of age, heart failure and/or left ventricular dysfunction after AMI).

Results: Mean follow up was 958 (range 3-1222) days. 121 patients received losartan, 115 captopril. Of 34 patients who died, 14 occurred ≦30, and 20 at >30 days. 40 patients suffered reinfarction and 134 were rehospitalised for a total of 3080 days. Pre-randomisation levels of BNP, N-BNP and N-ANP but not CNP (3.64 vs 2.95 pM, p=0.277) were higher in patients who later died (Table). Pre-randomisation levels of BNP (p=0.001), N-BNP (p=0.004) and N-ANP (p=0.012) were predictive of death ≦ 30 days. In contrast only pre-randomisation N-BNP (p=0.05), but not BNP (p=0.794) or N-ANP (p=0.412), predicted death >30 days. No peptide predicted reinfarction during follow-up.While peptide levels at randomisation or 1 month did not predict later hospital days, BNP (p=0.017), N-ANP (p=0.001) and particularly N-BNP (p<0.0005) at 1 year predicted the number of hospital days after 1 year.

Conclusions: Natriuretic peptide levels measured subacutely from AMI provide important prognostic information. Higher levels of BNP, N-BNP and N-ANP, but not CNP, are associated with increased mortality after complicated AMI. N-BNP has the best predictive value for death during follow-up. Peptide levels measured later (at 1 year) are also predictive of later morbidity as measured by days spent in hospital.