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