Coronary artery disease
Plasma levels of N-terminal pro-brain natriuretic peptide in patients with coronary artery disease and relation to clinical presentation, angiographic severity, and left ventricular ejection fraction

https://doi.org/10.1016/j.amjcard.2004.10.034Get rights and content

Comparative assessment of N-terminal pro-brain natriuretic peptide (NT–pro-BNP) across a wide spectrum of angiographic and clinical coronary artery disease (CAD) in a consecutive series of patients has not been reported. This study examined 879 subjects (684 patients who had angiographically proved CAD and 195 controls who did not have CAD). NT–pro-BNP concentrations were measured before an angiographic procedure that allowed diagnosis of CAD and measurements of left ventricular ejection fraction and end-diastolic blood pressure. Median values (25th and 75th percentiles) of NT–pro-BNP in patients and controls were 474.5 pg/ml (162.3 and 1,542.8) and 117.0 pg/ml (60.1 and 230.6), respectively (p <0.001). In patients who had stable angina, unstable angina, and acute myocardial infarction, NT–pro-BNP concentrations were 327.7 pg/ml (129.2 and 973.2), 660.6 pg/ml (201.2 and 1,563.5), and 1,045.0 pg/ml (323.8 and 2,486.0, p <0.001). NT–pro-BNP concentrations in subgroups with 1-, 2-, and 3-vessel CAD were 385.5 pg/ml (117.2 and 1,266.0), 463.0 pg/ml (135.0 and 1,480.5), and 533.8 pg/ml (221.8 and 1,809.4), respectively (p = 0.005). Multivariable analysis showed that NT–pro-BNP was an independent correlate of the presence of CAD (chi-square 10.8, odds ratio 1.08, 95% confidence interval 1.03 to 1.13 for 100-pg/ml increase in concentration; p <0.001), acute coronary syndromes (chi-square 6.3, odds ratio 1.01, 95% confidence interval 1.00 to 1.02 for 100-pg/ml increase in concentration, p = 0.01) and a strong trend that was independently associated with angiographic severity (chi-square 3.68, p = 0.055). This study shows that NT–pro-BNP concentrations are high across the entire spectrum of CAD and parallel the clinical or angiographic severity of CAD.

Section snippets

Patients

This case-control study examined 879 patients who underwent angiographic examination and coronary stenting due to significant CAD from August 2001 to February 2002 in the Deutsches Herzzentrum (Munich, Germany). A consecutive series of 684 patients who had angiographically proved significant CAD (385 patients who had stable angina, 108 who had unstable angina, and 191 who had AMI) formed the patient group. The control group consisted of 195 subjects who had normal coronary artery angiograms

Characteristics of patients and controls

Distribution of the main cardiovascular risk factors among patients and controls is presented in Table 1. As expected, patients versus control subjects had a more adverse cardiovascular risk profile. Patients were older and there were fewer women compared with control subjects. Diabetes, arterial hypertension, and hypercholesterolemia were encountered in a larger proportion of patients than of controls. Higher levels of C-reactive protein and of creatinine were found in patients compared with

Discussion

This study indicates that concentrations of NT–pro-BNP are increased across the entire spectrum of clinical CAD. Further, data from this study demonstrate, in a consecutive series of patients who had CAD, that the level of NT–pro-BNP parallels the severity of myocardial ischemia. On a median basis, patients who had stable angina, those who had unstable angina, and those who had AMI showed increases of 2.8-, 5.6-, and 8.9-fold in concentrations of NT–pro-BNP compared with control subjects who

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