Boston, MA- B-type natriuretic peptide (BNP) is
released from cardiac myocytes in
response to increased wall stress and is elevated in
response to myocardial ischemia. BNP levels are used
as prognostic markers of Acute Coronary Syndrome (ACS)
and response to therapy for ACS. David Morrow, MD,
MPH et al from Brigham and Women’s Hospital
conducted a study evaluating serial measurements of
BNP during extended follow-up of patients after ACS,
thereby determining the prognostic value of BNP
prior to hospital discharge, at four months and at
12 months after discharge. The study, published in
the December 14, 2005 issue of the Journal of the
American Medical Association, found serial
determinations of BNP levels during
outpatient follow-up after ACS predict the risk of
death or new CHF.
A group of 4497 patients with non-ST elevation or
ST-elevation ACS participated in this prospective,
observational study. Samples of plasma were obtained
prior to randomization into the trial,
shortly after onset of symptoms, and at outpatient
follow-up at 4 months and 12 months.
Levels of BNP were available in 4266 patients
at study entry (prior to hospital discharge),
3618 patients at 4 months, and 2966
patients at 12 months. During follow-up
there were 230 deaths and 163 incident cases of CHF.
Adjusting for age, sex, index event,
renal function, hypertension, prior heart
failure, and diabetes, elevated levels of BNP (>80
pg/mL) were associated with subsequent death
or new CHF when measured at study entry
(111 [21%] vs 246 [7%]; adjusted hazard
ratio [HR], 2.5; 95% confidence interval [CI],
2.0-3.3), at 4 months (34 [19%] vs 125
[4%]; adjusted HR, 3.9; 95% CI, 2.6-6.0),
and at 12 months (19 [11%] vs 37 [1%]; adjusted HR,
4.7; 95% CI, 2.5-8.9). Patients with
newly elevated levels of BNP at 4 months
were at increased risk of death or new CHF (10 [15%]
vs 105 [3%]); HR, 4.5; 95% CI, 2.3-8.6).
Patients with elevated levels of BNP at
study entry and with BNP levels lower than
80 pg/mL at 4 months tended to have only
modestly increased risk (HR, 1.7; 95% CI,
1.0-2.9) compared with patients with BNP
levels lower than 80 pg/mL at both visits.
Serial determinations of BNP levels during
outpatient follow-up after ACS predict the
risk of death or new CHF. Changes in BNP
levels over time are associated with
long-term clinical outcomes and may provide a basis
for enhanced clinical decision making in
patients after onset of ACS.
Co-authors: David A. Morrow, MD, MPH; James A. de
Lemos, MD; Michael A. Blazing, MD; Marc S. Sabatine,
MD, MPH; Sabina Murphy, MPH, Petr Jarolim MD, PhD;
Harvey White, DSc; Keith A.A. Fox, MB, ChB; Robert
Califf, MD; Eugene Braunwald, MD; for the A to Z
Investigators