Risk stratification after acute myocardial infarction: role of neurohormones, inflammatory markers and albumin excretion rate.

Activation of several neurohormonal systems occurs during acute myocardial infarction (AMI) and is associated with short- and long-term outcomes. In the last few years, many circulating factors have received close attention but it is not clear which are the best prognostic indicators of mortality. Renin and natriuretic cardiac peptides appeared to be strong predictors of outcome in patients with AMI, and could represent helpful markers of risk in these patients. Though the role of acute inflammatory markers has been investigated only recently, mounting evidence indicates that C-reactive protein is also associated with an adverse outcome after AMI. Recent research from our laboratory indicates that the albumin excretion rate (AER) is a powerful predictor of the in-hospital and 3-year mortality in patients with AMI and that its prognostic power is stronger than that shown by other humoral markers of risk or by clinical and echocardiographic signs of congestive heart failure. The reason why AER is so closely associated with an adverse prognosis is not completely understood, but the available data support the hypothesis that it reflects both the hemodynamic as well as the inflammatory changes which accompany AMI. The determination of the brain natriuretic peptide and of C-reactive protein appears to be a valuable tool in the risk stratification of subjects with AMI. Even though available evidence is still limited, the evaluation of AER could be useful for the identification of those patients at higher risk for whom additional preventive and therapeutic measures would be advisable.