Key result
Both biomarkers predicted MACE, but NT-proBNP was superior to BNP for net risk reclassification when added to traditional risk factors (C statistic 0.76 vs 0.72, P<0.001).
Why the study?
Does NT-proBNP or BNP better predict major adverse cardiovascular events in patients with stable coronary heart disease?
Cohort (n=983)
Does NT-proBNP or BNP better predict major adverse cardiovascular events in patients with stable coronary heart disease?
Hazard Ratio: 1.84 (95% CI 1.52–2.24)
p-value: p=<0.001
In patients with stable coronary heart disease, NT-proBNP is superior to BNP for predicting major adverse cardiovascular events and improving risk reclassification.
May support NT-proBNP over BNP for risk reclassification in stable CHD; hypothesis-generating and should not yet change practice.
BACKGROUND: Brain-type natriuretic peptide (BNP) and the amino-terminal fragment of its prohormone (NT-proBNP) are known predictors of cardiovascular outcomes in patients with coronary heart disease; however, the relative prognostic value of these 2 biomarkers for secondary events remains unclear. METHODS AND RESULTS: In 983 participants with stable coronary heart disease, we evaluated the association of BNP and NT-proBNP with time to hospitalization for heart failure, nonfatal myocardial infarction, stroke or transient ischemic attack, cardiovascular death, and combined major adverse cardiovascular events (MACE). During an average follow-up of 6.5±3.3 years, both BNP and NT-proBNP were associated with increased risk of MACE in a multivariable-adjusted model (hazard ratio per standard deviation of log BNP: 1.58; 95% CI: 1.32 to 1.89; hazard ratio per standard deviation of log NT-proBNP: 1.84; 95% CI: 1.52 to 2.24). When added to traditional risk factors, NT-proBNP predicted MACE better than BNP (C statistic: 0.76 versus 0.72, P<0.001). Similarly, the addition of NT-proBNP resulted in a greater net reclassification improvement for predicting MACE than the addition of BNP (65% for NT-proBNP, 56% for BNP). CONCLUSIONS: Both BNP and NT-proBNP were significant predictors of MACE in stable coronary heart disease; however, NT-proBNP was superior to BNP for net risk reclassification for MACE.
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Mishra et al. (2014) conducted a cohort in stable coronary heart disease (n=983). NT-proBNP vs. BNP was evaluated on combined major adverse cardiovascular events (MACE) (HR 1.84, 95% CI 1.52-2.24, p=<0.001). Both biomarkers predicted MACE, but NT-proBNP was superior to BNP for net risk reclassification when added to traditional risk factors (C statistic 0.76 vs 0.72, P<0.001).
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