Key result
B-type natriuretic peptide levels >80 pg/ml independently predicted CAD severity and coronary vessel involvement (AUC 0.80; P=0.0001) with 78% sensitivity and 72% specificity.
Why the study?
It is not established if early BNP measurements provide additional information to troponin and ECG analysis in patients with CAD without ventricular enlargement and preserved systolic function.
Does early BNP measurement predict CAD severity and coronary vessel involvement in patients with non-ST elevation coronary syndromes and preserved systolic function?
Observational (n=280)
Does early BNP measurement predict CAD severity and coronary vessel involvement in patients with non-ST elevation coronary syndromes and preserved systolic function?
Answers are grounded in this paper and cite their sources.
In patients with non-ST elevation coronary syndromes and preserved systolic function, a BNP level >80 pg/ml is an independent predictor of multivessel coronary artery disease.
OBJECTIVE: B-type natriuretic peptide (BNP) has been employed as a risk marker in patients with coronary artery disease (CAD) with ST elevation and non-ST elevation. It is not yet established if early BNP measurements provide additional information to troponin and electrocardiographic analysis in patients without ventricular enlargement and systolic dysfunction. DESIGN: This study compared BNP levels in patients with stable angina (SA) and acute coronary syndromes with non-ST elevation in relation to angiographic lesions (NSTEMI-ACS). Moreover, the diagnostic utility of BNP was determined using the receiver operating characteristic curve. PATIENTS: 280 patients with CAD without ST elevation and preserved systolic function were studied. BNP samples were measured in all recruited patients within 24 hours of hospitalization. RESULTS: BNP values increased progressively with the severity of diagnosis: SA (n = 85; 50.4 ± 50 pg/ml) NSTEMI-ACS (n = 195; 283 ± 269 pg/ml; p < 0.0001). The analysis of BNP in relation to the number of involved vessels demonstrated significantly increased levels in patients with multivessel disease compared to patients with 1- or 2-vessel disease (p < 0.001 and p < 0.003). Values of BNP >80 pg/ml were shown to be able to predict CAD severity and coronary vessel involvement (AUC = 0.80; p = 0.0001) with a sensitivity of 78% and a specificity of 72%. In multivariate analysis, BNP levels >80 pg/ml, CAD history, and ST deviation >2 mm were confirmed as independent predictors of CAD severity. CONCLUSIONS: Circulating BNP levels appear elevated in NSTEMI-ACS, without left ventricular systolic dysfunction. A BNP cut-off value of 80 pg/ml is a good predictor of CAD extension.
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Palazzuoli et al. (2011) conducted an observational in Coronary artery disease without ST elevation and preserved systolic function (n=280). B-type natriuretic peptide (BNP) >80 pg/ml vs. BNP ≤80 pg/ml was evaluated on CAD severity and coronary vessel involvement (AUC 0.80, p=0.0001). B-type natriuretic peptide levels >80 pg/ml independently predicted CAD severity and coronary vessel involvement (AUC 0.80; P=0.0001) with 78% sensitivity and 72% specificity.
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