Key result
NT-proBNP links to ~67% higher three-vessel CAD odds but adds no predictive value over traditional risks.
Why the study?
The usefulness of NT-proBNP as a predictive marker for angiographically significant CAD and CAD severity compared with other newer biochemical markers and traditional risk factors was uncertain.
Does NT-proBNP improve the prediction of angiographically significant CAD compared with traditional risk factors in patients with suspected CAD?
Cross-Sectional (n=848)
No
Does NT-proBNP improve the prediction of angiographically significant CAD compared with traditional risk factors in patients with suspected CAD?
NT-proBNP is associated with CAD severity but does not add predictive value over traditional risk factors for identifying significant CAD in stable patients.
Answers are grounded in this paper and cite their sources.
NT-proBNP should not yet inform CAD prediction in stable patients; leaves open its association with three-vessel disease for prospective validation.
OBJECTIVE: To investigate the usefulness of N-terminal pro-brain natriuretic peptide (NT-proBNP) as a predictive marker for angiographically significant coronary artery disease (CAD) and CAD severity compared with other newer biochemical risk markers and classic risk factors in patients with clinically suspected CAD. DESIGN: Cross-sectional evaluation of NT-proBNP in a large consecutive series of patients without a history of myocardial infarction referred for elective coronary angiography (CAG) between March 2004 and January 2005. The value of NT-proBNP for predicting CAD was assessed and compared with high sensitivity C-reactive protein (hs-CRP), gamma-glutamyltransferase (GGT) and traditional risk factors. SETTING: Tertiary care centre, Department of Cardiology, Innsbruck Medical University, Austria. PATIENTS: 561 men and 287 women aged between 20-86 years (median 65 years). INTERVENTIONS: None. MAIN OUTCOME MEASURES: Association of NT-proBNP with the severity of CAD, left ventricular dysfunction and comparison of predictive values of NT-proBNP, hs-CRP, GGT and traditional CAD risk factors. RESULTS: Of all tested newer biochemical risk markers NT-proBNP performed best. In a multinomial logistic regression model NT-proBNP but not hs-CRP or GGT was significantly associated with three-vessel CAD adjusted for age, sex, ventricular, renal function and classic risk factors (odds ratio = 1.667; 95% CI 1.003 to 2.772; p = 0.049). However, NT-proBNP had no additive predictive value to traditional cardiovascular risk factors for the prediction of angiographically significant CAD in a binary logistic regression model. CONCLUSIONS: The predictive value of NT-proBNP for CAD severity is better than that of hs-CRP or GGT. However, NT-proBNP is also of limited value compared with traditional risk factors for predicting significant CAD.
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Peer et al. (2008) conducted a cross-sectional in clinically suspected coronary artery disease (n=848). NT-proBNP vs. hs-CRP, GGT, and traditional risk factors was evaluated on three-vessel CAD (OR 1.667, 95% CI 1.003 to 2.772, p=0.049). NT-proBNP was significantly associated with three-vessel CAD (OR 1.667; 95% CI 1.003-2.772; p=0.049) but had no additive predictive value to traditional risk factors for significant CAD.
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