Multicenter Prospective Investigation on Efficacy and Safety of Carperitide for Acute Heart Failure in the 'Real World' of Therapy

BACKGROUND: Efficacy and safety assessments for carperitide (alpha-human atrial natriuretic peptide) in previous clinical trials have not mentioned its limitations in practice as therapy for acute heart failure. METHODS AND RESULTS: A 6-year prospective open-label registry analysis was conducted in the 'real world' of therapy for 3,777 patients with acute heart failure (male 57%, median age 73) treated with 0.085 microg . kg(-1) . min(-1) (median, interquartile 0.05-0.1) of carperitide for 65 h (median, interquartile 22-142); 51% were assessed as class III or IV according to the Killip classification; 82% of the patients were assessed as clinically improved after carperitide treatment. The efficacy limitation was related to the underlying disease (acute myocardial infarction), severity of Killip classification (Class IV), and renal function disturbance. The efficacy was significantly higher in patients with decompensated chronic heart failure (ie, cardiomyopathy, valvular diseases, and hypertensive heart disease). Incidence of adverse events was 16.9%, the most frequent being blood pressure lowering (9.5%), which occurred in the first 3 h of infusion, with 96% of patients recovering or improving without specific treatment. Logistic regression analysis revealed that factors predicting mortality (11.4%) during 7 days of follow-up were age, Killip classification, renal function disturbance, low blood pressure and use of vasopressors. CONCLUSION: The clinical condition improved in 82% of patients treated with carperitide. Based on these findings, minute strategy will be established for carperitide therapy within the strata of patient characteristics that may predict the prognosis.