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Circulating Levels of N-Terminal Pro-Brain Natriuretic Peptide are a Strong Prognostic Biomarker for Patients with Chronic Stable Angina

October 7, 2005

By Sahar Bedrood B.S. and Asher Kimchi M.D.

Munich, Germany - Biomarkers of necrosis, inflammation and vascular damage have become important indicators of damage associated with acute coronary syndromes. However, there are less available biomarkers for chronic stable angina. Recent studies demonstrated N-terminal pro-brain natriuretic peptide (NT-proBNP) is increased in patients with acute myocardial infarction and stable coronary artery disease. Gjin Ndrepepa, M.D., et al from the Technische Universitat Munchen in Munich, Germany compared plasma levels of NT-proBNP in patients with chronic stable angina to mortality rate. The study, published in the October 4, 2005 issue of Circulation found that circulating levels of NT-proBNP are a strong prognostic biomarker for patients with chronic stable angina.

Plasma levels of NT-proBNP were measured in 1059 patients with chronic stable angina and coronary angiographic confirmation of significant coronary artery disease. The primary end point of the study was mortality. After a median of 3.6 years (interquartile range, 3.3 to 4.5 years), there were 106 deaths. Kaplan-Meier estimates of 5-year mortality were 4.7% in the first quartile, 7.8% in the second quartile, 11.4% in the third quartile, and 32.7% in the fourth quartile of NT-proBNP (P<0.001). A Cox proportional hazards model showed that NT-proBNP was the strongest correlate of mortality (adjusted hazards ratio [HR], 5.83 [95% confidence interval: 2.07 to 16.44] for the fourth versus the first quartile). A similar prognostic value of NT-proBNP was demonstrated for cardiovascular mortality (HR, 5.98 [1.55 to 23.13] for the fourth versus the first quartile) and for patients with New York Heart Association classes I and II (HR, 6.03 [2.07 to 17.52] for the fourth versus the first quartile).

Overall, patients with chronic stable angina have poorly characterized biomarkers that help in the assessment of prognosis or therapeutic agents. This large cohort study concludes that NT-proBNP is a powerful predictor of mortality. Mortality is higher in patients whose levels are in the upper quartile of NT-proBNP. Further studies can investigate how NT-proBNP can be sued as a therapeutic guide.

Co-authors: Gjin Ndrepepa, MD; Siegmund Braun, MD; Kathrin Niemöller, MD; Julinda Mehilli, MD; Nicolas von Beckerath, MD; Olga von Beckerath, MD; Wolfgang Vogt, MD; Albert Schömig, MD; Adnan Kastrati, MD


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