title: NT-probrain natriuretic peptide predicts complexity and severity of the coronary lesions in patients with non-ST-elevation acute coronary syndromes.
abstract: 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.
authors.affiliation: Hospital Italiano de Buenos Aires, Ciudad de Buenos Aires, Buenos Aires, Argentina. jose.navarroestrada@hospitalitaliano.org.ar
authors.forename: José Luis
authors.initials: JL
authors.lastname: Navarro Estrada
authors.forename: Fernando
authors.initials: F
authors.lastname: Rubinstein
authors.forename: Maria Cecilia
authors.initials: MC
authors.lastname: Bahit
authors.forename: Florencia
authors.initials: F
authors.lastname: Rolandi
authors.forename: Diego
authors.initials: D
authors.lastname: Perez de Arenaza
authors.forename: Jose M
authors.initials: JM
authors.lastname: Gabay
authors.forename: Jose
authors.initials: J
authors.lastname: Alvarez
authors.forename: Ricardo
authors.initials: R
authors.lastname: Sarmiento
authors.forename: Carlos
authors.initials: C
authors.lastname: Rojas Matas
authors.forename: Carlos
authors.initials: C
authors.lastname: Sztejfman
authors.forename: Alejandro
authors.initials: A
authors.lastname: Tettamanzi
authors.forename: Raul
authors.initials: R
authors.lastname: de Miguel
authors.forename: Luis
authors.initials: L
authors.lastname: Guzman
mesh_terms: 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
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain