title: Prognostic value of B-Type natriuretic peptides in patients with stable coronary artery disease: the PEACE Trial.
abstract: OBJECTIVE
  The purpose of this study was to assess the association between B-type natriuretic peptide (BNP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) and the incidence of specific cardiovascular events in low-risk patients with stable coronary disease, the incremental prognostic information obtained from these two biomarkers compared with traditional risk factors, and their ability to identify patients who may benefit from angiotensin-converting enzyme (ACE) inhibition.
  
  
  BACKGROUND
  The prognostic value of BNPs in low-risk patients with stable coronary artery disease remains unclear.
  
  
  METHODS
  Baseline plasma BNP and NT-proBNP concentrations were measured in 3,761 patients with stable coronary artery disease and preserved left ventricular function participating in the PEACE (Prevention of Events With Angiotensin-Converting Enzyme Inhibition) study, a placebo-controlled trial of trandolapril. Multivariable Cox regression was used to assess the association between natriuretic peptide concentrations and the incidence of cardiovascular mortality, fatal or nonfatal myocardial infarction, heart failure, and stroke.
  
  
  RESULTS
  The BNP and NT-proBNP levels were strongly related to the incidence of cardiovascular mortality, heart failure, and stroke but not to myocardial infarction. In multivariable models, BNP remained associated with increased risk of heart failure, whereas NT-proBNP remained associated with increased risk of cardiovascular mortality, heart failure, and stroke. By C-statistic calculations, BNP and NT-proBNP significantly improved the predictive accuracy of the best available model for incident heart failure, and NT-proBNP also improved the model for cardiovascular death. The magnitude of effect of ACE inhibition on the likelihood of experiencing cardiovascular end points was similar, regardless of either BNP or NT-proBNP baseline concentrations.
  
  
  CONCLUSIONS
  In low-risk patients with stable coronary artery disease and preserved ventricular function, BNPs provide strong and incremental prognostic information to traditional risk factors.
authors.affiliation: Department of Medicine, Akershus University Hospital, Lorenskog, Norway. torbjorn.omland@medisin.uio.no
authors.forename: Torbjørn
authors.initials: T
authors.lastname: Omland
authors.forename: Marc S
authors.initials: MS
authors.lastname: Sabatine
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Jablonski
authors.forename: Madeline Murguia
authors.initials: MM
authors.lastname: Rice
authors.forename: Judith
authors.initials: J
authors.lastname: Hsia
authors.forename: Ragnhild
authors.initials: R
authors.lastname: Wergeland
authors.forename: Sverre
authors.initials: S
authors.lastname: Landaas
authors.forename: Jean L
authors.initials: JL
authors.lastname: Rouleau
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Domanski
authors.forename: Christian
authors.initials: C
authors.lastname: Hall
authors.forename: Marc A
authors.initials: MA
authors.lastname: Pfeffer
authors.forename: Eugene
authors.initials: E
authors.lastname: Braunwald
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage*; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000097:blood* / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D007211:Indoles / Q000627:therapeutic use*; D008875:Middle Aged; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011336:Probability; D011379:Prognosis; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D015415:Biomarkers; D007211:Indoles; D020097:Natriuretic Peptide, Brain; C052035:trandolapril