Predictors of Long-Term Risk for Heart Failure Hospitalization after Acute Myocardial Infarction


  • This study was supported in part by grants from the Medical Council of the Finnish Academy of Science, and the Sigrid Juselius Foundation, Helsinki, Finland.

Address for correspondence: Juha S. Perkiömäki, M.D., Division of Cardiology, Department of Medicine, P.O. Box 5000 (Kajaanintie 50), FIN-90014 University of Oulu, Oulu, Finland. Fax: +358-8-315 5599; E-mail:


Background: Data on the value of baseline brain natriuretic peptide (BNP) and autonomic markers in predicting heart failure (HF) hospitalization after an acute myocardial infarction (AMI) are limited.

Methods: A consecutive series of patients with AMI without a previous history of HF (n = 569) were followed up for 8 years. At baseline, the patients had a blood sample for determination of BNP, a 24-hour Holter recording for evaluating heart rate variability (HRV) and heart rate turbulence (HRT), and an assessment of baroreflex sensitivity (BRS) using phenylephrine test.

Results: During the follow-up, 79 (14%) patients were hospitalized due to HF. Increased baseline BNP, decreased HRV, HRT, and BRS had a significant association with HF hospitalization in univariate comparisons (P < 0.001 for all). After adjusting with all the relevant clinical parameters, BNP, HRV, and HRT still significantly predicted HF hospitalization (P < 0.001 for BNP and for the short-term scaling exponent α1, P < 0.01 for turbulence slope). In the receiver operator characteristics curve analysis, the area under the curve for BNP was 0.77, for the short-term scaling exponent α1 0.69, for turbulence slope 0.71, and for BNP/standard deviation of all N-N intervals ratio 0.80.

Conclusion: Baseline increased BNP and impaired autonomic function after AMI yield significant information on the long-term risk for HF hospitalization.

Ann Noninvasive Electrocardiol 2010;15(3):250–258