January 1, 2005Circulation Journal21 citationsOpen Access

N-Terminal Pro-B-Type Natriuretic Peptide Predicts Significant Coronary Artery Lesion in the Unstable Angina Patients With Normal Electrocardiogram, Echocardiogram, and Cardiac Enzymes

SHSeo Na Hong NYNam Sik Yoon YAYoungkeun Ahn

Structured PICO

Does elevated NT-proBNP predict significant coronary artery disease in unstable angina patients with normal ECG, echocardiogram, and cardiac enzymes?

Population

161 patients with unstable angina (mean age 61.0, 54.0% male) with normal ventricular function (LVEF >55% and no regional wall motion abnormality by echocardiography), normal troponin I level (<0.05 ng/ml), normal C-reactive protein, normal myoglobin, and normal ECG (no Q wave or ST-T changes).

Intervention

Measurement of serum NT-proBNP levels on admission (evaluating a cut-off of >200 pg/ml)

Comparator

Patients without significant coronary artery disease or with NT-proBNP ≤200 pg/ml

Outcome

Presence of significant coronary artery disease (CAD) assessed by coronary angiography within 5 days of admissionsurrogate

In patients with unstable angina and normal ECG, echocardiogram, and cardiac enzymes, an elevated NT-proBNP level (>200 pg/ml) is a strong independent predictor of significant coronary artery disease.

Limitations

Blood sampling was not always done at the same time for each patient, potentially not reflecting the acute phase concentration.
There were more men in the CAD group, and NT-proBNP is generally lower in males.
The clinical implication of NT-proBNP in treatment response was not evaluated.
There is poor evidence for setting the cut-off value of NT-proBNP at 200 pg/ml.
Diastolic function was not investigated.

Abstract

BACKGROUND: Brain natriuretic peptide (BNP) and N-terminal pro-brain natriuretic peptide (NT-proBNP) are not specific for ventricular dysfunction and other cardiac processes, such as myocardial ischemia, may also cause elevation of these markers. METHODS AND RESULTS: To determine whether elevation of NT-proBNP without elevation of cardiac specific markers can predict coronary artery disease (CAD), the serum level of NT-proBNP was measured in 161 patients with unstable angina (61.0+/-8.1 years, male 54.0%) with normal ventricular function (left ventricular ejection fraction >55% and no regional wall motion abnormality by echocardiography) and normal troponin I level (200 pg/ml, elevated NT-proBNP level shows high probability of CAD (odds ratio, 10.1; 95% confidence interval, 2.6-38.7, p=0.001). The NT-proBNP level positively correlated with the extent of CAD (r=0.329, p=0.001). In multivariate analysis, the NT-proBNP was an independent predictor of CAD. CONCLUSION: These results suggested that NT-proBNP is a useful screening test for CAD in the unstable angina patients with normal ECG, echocardiogram and cardiac enzyme levels.

Demander à l'IA

Bookmark

View Full Paper