November 30, 2004

Analysis of N-terminal-pro-brain natriuretic peptide and C-reactive protein for risk stratification in stable and unstable coronary artery disease: results from the AtheroGene study

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Coronary artery disease (n=904). Intervention: N-terminal-pro-brain natriuretic peptide (Nt-proBNP) vs. Lowest quartile of Nt-proBNP. Primary outcome: Cardiovascular events (HR 4.0, p=0.03).

Q: What does this research mean for the field?

Baseline Nt-proBNP in the highest quartile is independently associated with an increased risk of future cardiovascular events in patients with stable angina. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Key Result

Baseline Nt-proBNP in the highest quartile was independently associated with an increased risk of future cardiovascular events in patients with stable angina (HR 4.0; P=0.03).

Study Design

Type

Cohort (n=904)

Structured PICO

Does baseline Nt-proBNP level predict future cardiovascular events in patients with stable coronary artery disease?

Population

904 consecutive patients with coronary artery disease (CAD), including subgroups with stable angina pectoris (SAP) and acute coronary syndrome.

Intervention

Baseline N-terminal-pro-brain natriuretic peptide (Nt-proBNP) measurement (top quartile >487.9 pg/mL)

Comparator

Lower baseline Nt-proBNP levels (lowest quartile)

Outcome

Cardiovascular eventscomposite

Baseline Nt-proBNP is an independent predictor of future cardiovascular events in patients with stable angina, extending its prognostic utility beyond acute coronary syndromes.

Main Result

Effect estimate: HR 4.0

p-value: p=0.03

Abstract

AIMS: N-terminal-pro-brain natriuretic peptide (Nt-proBNP) is a reliable risk predictor in acute coronary artery disease (CAD). Little is known about patients with stable angina pectoris (SAP). We aimed to investigate the prognostic impact of Nt-proBNP in a population with CAD especially focussing on patients with SAP. METHODS AND RESULTS: We obtained baseline samples from a prospective cohort of 904 consecutive patients with CAD. Cardiovascular events were registered during follow-up (median 2 years; maximum 3.7 years). Baseline Nt-proBNP was significantly higher among individuals with cardiovascular events compared with those without (711.5 vs. 238.8 pg/mL; P487.9 pg/mL) had a 3.7-fold (95% CI 1.2-9.1; P=0.01) increase in cardiovascular risk. After adjustment for most potential confounders including left ventricular ejection fraction, Nt-proBNP remained predictive for patients with serum concentrations in the upper quartile in comparison with patients in the lowest quartile (hazard ratio highest vs. lowest quartile: 4.0; P=0.03) (n=417). CONCLUSION: Baseline concentration of Nt-proBNP is independently related to future cardiovascular events in patients with stable angina.

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Cite This Study

Schnabel et al. (Tue,) conducted a cohort in Coronary artery disease (n=904). N-terminal-pro-brain natriuretic peptide (Nt-proBNP) vs. Lowest quartile of Nt-proBNP was evaluated on Cardiovascular events (HR 4.0, p=0.03). Baseline Nt-proBNP in the highest quartile was independently associated with an increased risk of future cardiovascular events in patients with stable angina (HR 4.0; P=0.03).

synapsesocial.com/papers/6a15d47c4718e7db3a521ebf https://doi.org/https://doi.org/10.1093/eurheartj/ehi036