NT-proBNP as a marker of coronary artery disease burden in chronic coronary syndromes

BACKGROUND Evidence regarding the role of N-terminal pro-brain natriuretic peptide (NTproBNP) in chronic coronary syndrome (CCS) remains limited. We aimed to investigate the association between plasma NTproBNP levels and the presence and extent of coronary artery disease (CAD) in a prospective real-world cohort. METHODS This prospective observational cross-sectional study included 676 consecutive patients (mean age 67 ± 7 years; 20% women) referred for elective coronary angiography for suspected CCS, as part of the BNP-CAD study (ClinicalTrials.govNCT07013344). Patients with conditions known to elevate NTproBNP were excluded. Obstructive CAD was defined as stenosis ≥70% (≥50% for the left main). Prognostically significant CAD was defined as involvement of the left main or proximal LAD artery. RESULTS Obstructive CAD was identified in 432 patients (64%). NTproBNP levels were significantly higher in patients with obstructive CAD compared to those without (124 vs. 96 pg/mL, p < 0.001) and increased with the number of vessels involved and degree of stenosis. After adjustment for clinical confounders and high-sensitivity troponin T, NT-proBNP remained independently associated with obstructive CAD (OR per 100 pg/mL increase: 1.18; 95% CI: 1.03-1.36; p = 0.021). Prognostically significant CAD was present in 197 patients (46% of those with obstructive CAD) and was associated with higher NT-proBNP levels (133 vs. 107 pg/mL; p = 0.006), although discriminatory performance remained modest (AUC: 0.60; 95% CI: 0.55-0.64). CONCLUSION NT-proBNP was independently associated with obstructive CAD and correlated with coronary disease burden. However, its modest discriminatory performance precludes its use as a stand-alone diagnostic test for high-risk coronary anatomy.