NT-probrain natriuretic peptide predicts complexity and severity of the coronary lesions in patients with non-ST-elevation acute coronary syndromes.
NT-probrain natriuretic peptide (NT-proBNP) has been associated with left ventricular (LV) dysfunction and adverse outcome in patients with non-ST-elevation acute coronary syndromes (NSTEACS). However, the underlying pathophysiological mechanisms responsible for this association have not been well established. We sought to explore the relation between NT-proBNP levels and extension of coronary artery disease (CAD) and the presence of more complex and severe coronary lesions.


METHODS
This prospective, multicenter angiographic substudy included 585 patients admitted with NSTEACS. Blinded measurements of NT-proBNP and troponin T were performed at a median time of 3 hours after admission and analyzed centrally. Angiograms were read at a core laboratory by 2 independent readers blinded to patient data. Complex coronary lesion was defined as the presence of at least one of the following: thrombus (+), TIMI flow < 2, or ulcerated plaque.


RESULTS
NT-probrain natriuretic peptide levels increased proportionally as LV function decreased. The levels of NT-proBNP were directly related to the extent of the CAD. This association was maintained when we analyzed patients with normal LV function (n = 257). Patients with complex coronary lesions or those with at least one of its individual component had higher levels of NT-proBNP compared with those without complex coronary lesions. After adjusting for clinical and electrocardiographic variables and other biomarkers, positive troponin (OR 2.20, 95% CI 1.50-3.22, P < .0001) and supramedian NT-proBNP levels (OR 1.72, 95% CI 1.19-2.47, P = .003) independently contributed to the prediction of complex coronary lesions.


CONCLUSIONS
In this study of patients with NSTEACS, NT-proBNP levels progressively increase with the severity of CAD and degree of LV dysfunction. Increased levels of NT-proBNP independently predict the presence of more complex coronary lesions.
Navarro Estrada
José Luis
JL
Hospital Italiano de Buenos Aires, Ciudad de Buenos Aires, Buenos Aires, Argentina. jose.navarroestrada@hospitalitaliano.org.ar
Rubinstein
Fernando
F
Bahit
Maria Cecilia
MC
Rolandi
Florencia
F
Perez de Arenaza
Diego
D
Gabay
Jose M
JM
Alvarez
Jose
J
Sarmiento
Ricardo
R
Rojas Matas
Carlos
C
Sztejfman
Carlos
C
Tettamanzi
Alejandro
A
de Miguel
Raul
R
Guzman
Luis
L
D000208:Acute Disease; D000368:Aged; D017023:Coronary Angiography; D003327:Coronary Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D015337:Multicenter Studies as Topic; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index; D013577:Syndrome; D018487:Ventricular Dysfunction, Left / Q000209:etiology / Q000503:physiopathology
D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain