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The N-terminal fragment of the prohormone brain-type natriuretic peptide (NT-proBNP) is a powerful predictor of adverse outcomes in patients with coronary artery disease (CAD). However, the prognostic significance of longitudinal changes in NT-proBNP level remains uncertain. We evaluated the ability of 5-year change in NT-proBNP level to predict heart failure hospitalization (HF) or cardiovascular death (CVD) in patients with stable CAD.
We studied the prognostic utility of 5-year change in NT-proBNP in 635 participants with stable CAD from the Heart and Soul Study. The primary outcome was time to HF or CVD.
The median (IQR) 5-year change in NT-proBNP was 49.7 pg/mL (−5.0, 222.4). During an average of 4.0 ± 1.4 years follow-up, there were 67 events. Participants with 5-year change in the highest quartile of ≥ 222.7 pg/mL had an almost 4-fold greater risk of HF or CVD than those in the lowest quartile of ≤ −5.3 pg/mL (HR 3.81; 95% C.I. 1.98 – 7.33; p<0.001). This association remained strong after adjustment for demographic variables, CAD risk factors, renal function, left ventricular (LV) mass index, systolic and diastolic function and baseline NT-proBNP level (HR 2.67; 95% C.I. 1.22 – 5.81; p=0.01).
Five-year change in NT-proBNP predicts HF or CVD in patients with stable CAD, independent of other prognostic markers, including baseline NT-proBNP level. This suggests that tracking changes in NT-proBNP levels may have clinical utility among patients with stable CAD.
Moderated Poster Contributions
Poster Sessions, Expo North
Saturday, March 09, 2013, 10:00 a.m.-10:45 a.m.
Session Title: The Best of Risk Stratification in SIHD
Abstract Category: 10. Chronic CAD/Stable Ischemic Heart Disease: Clinical
Presentation Number: 1110M-72
- 2013 American College of Cardiology Foundation