Key result
Elevated NT-proBNP levels were strongly associated with increased mortality in unstable CAD, with the highest quartile having a relative risk of death of 26.6 (95% CI 10.8-65.5).
Why the study?
Does NT-proBNP level predict mortality and identify patients who benefit from an early invasive strategy in unstable coronary artery disease?
Does NT-proBNP level predict mortality and identify patients who benefit from an early invasive strategy in unstable coronary artery disease?
NT-proBNP is a strong independent predictor of mortality in unstable CAD and, combined with inflammatory markers, identifies patients who benefit most from an early invasive strategy.
Answers are grounded in this paper and cite their sources.
Supports NT-proBNP for mortality risk stratification in unstable CAD; leaves open its utility for selecting early invasive strategy candidates.
BACKGROUND: Risk stratification is important in patients with unstable coronary artery disease (CAD), i.e. unstable angina or non-ST-elevation myocardial infarction. This article focuses on the emerging role of N-terminal pro brain natriuretic peptide (NT-proBNP) and the results from the FAST, GUSTO IV and FRISC II trials. METHODS: In the FAST study, NT-proBNP was measured on admission in 755 patients admitted because of symptoms suggestive of unstable CAD. Follow up was performed after 40 months. The GUSTO IV and the FRISC II-trials included patients with unstable CAD and NT-proBNP was analyzed in 6806 and 2019 patients, with follow up after 1 and 2 years, respectively. RESULTS: In the FAST study, patients in the 2nd, 3rd, and 4th NT-proBNP quartile had a relative risk of subsequent death of 4.2 (1.6-11.1), 10.7 (4.2-26.8) and 26.6 (10.8-65.5), respectively. In the GUSTO IV trial, increasing quartiles of NT-proBNP were related to short and long term mortality which at 1 year was; 1.8%, 3.9%, 7.7% and 19.2% (P<0.001), respectively. In multivariable analyses including well-known predictors of outcome, NT-proBNP level was independently associated to mortality in all three studies. In the FRISC II trial, the NT-proBNP level, especially if combined with a marker of inflammation, identified those with the greatest benefit from an early invasive strategy. CONCLUSION: NT-proBNP is strongly associated with mortality in patients with suspected or confirmed unstable CAD and, combined with a marker of inflammation, seems helpful in identifying those with greatest benefit from an early invasive strategy.
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Jernberg et al. (2004) conducted a review in Unstable coronary artery disease (n=9,580). Elevated NT-proBNP vs. Lower NT-proBNP levels was evaluated on Mortality (RR 26.6, 95% CI 10.8-65.5, p=<0.001). Elevated NT-proBNP levels were strongly associated with increased mortality in unstable CAD, with the highest quartile having a relative risk of death of 26.6 (95% CI 10.8-65.5).
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