N-terminal pro-brain natriuretic peptide predicts angiographic progression of subclinical atherosclerotic disease in patients with stable angina and preserved left ventricular function
XU Yan-Lu, ZHENG Xin-Xin, ZHU Cheng-Gang, GUO Yuan-Lin, ZHENG Xin, TEN Si-Yong, GAO Zhan, MU Chao-Wei, YUAN Jin-Qing, LI Jian-Jun .Department of Cardiology, Fu Wai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, BeiLiShi Road 167, Beijing 100037, China
Objective N-terminal pro-brain natriuretic peptide (NT-proBNP) has been a strong prognostic biomarker regarding cardiovascular mortality for patients with chronic stable angina pectoris (CSA) treated with coronary stenting. However, its ability to predict angiographic adverse outcomes such as atherosclerosis progression and in-stent restenosis (ISR) remains unclear. We tested whether NT-proBNP could predict rapid angiographic progression (RAP) of non-target coronary artery atherosclerosis (NCAA) as well as ISR in SAP patients with preserved left ventricular (LV) function. Methods: We prospectively studied 303 consecutive CSA patients (236 men; mean age, 57±10 years) with preserved LV systolic function (ejection fraction50%) who underwent diagnostic coronary angiography (CAG) and percutaneous coronary intervention with stent implantation on initial admission and were scheduled to operate follow-up CAG by a mean of 8.5±1.2 months. RAP of NCAA and ISR were well defined and quantitatively evaluated. Peripheral blood samples for determination of NT-proBNP were drawn at baseline on initial admission and at follow-up. Results: All 303 patients underwent follow-up CAG and had preserved LV function at follow-up. No patients had death, non-fatal myocardial infarction, or heart failure during clinical follow-up. NCAA progression occurred in 133 patients (43.8%) while ISR were seen in 49 patients (16.2%). Baseline characteristics between groups with RAP (n=133) and without RAP (n=170) or with ISR (n=49) and without ISR (n=254) were similar. RAP patients had higher baseline concentrations of NT-proBNP than patients without RAP (median 455 vs 431 fmol/ml, P=0.017). The RAP rate increased across quartiles of the baseline NT-proBNP levels (P=0.037). In multivariate regression analysis, NT-proBNP at baseline independently predicted RAP of NCAA (Cutoff point= 515 fmol/ml, OR 1.944, 95% CI 1.047-3.608, P=0.035). However, NT-proBNP was not significantly associated with ISR in this population. Conclusions: NT-proBNP at baseline could be an independent predictor of RAP of NCAA rather than ISR in patients with CSA and with preserved LV systolic function.
【Fund】： 阜外心血管病医院博士生培养基金(No.2004190);; 国家自然科学基金(No.30670861 No.30871055andNo.81070171);; 北京市自然科学基金(No.7082081);; 教育部博士点基金(No.20070023047)
【CateGory Index】： R541.4
【CateGory Index】： R541.4