Prognostic value of B-Type natriuretic peptides in patients with stable coronary artery disease: the PEACE Trial.
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.
Omland
Torbjørn
T
Department of Medicine, Akershus University Hospital, Lorenskog, Norway. torbjorn.omland@medisin.uio.no
Sabatine
Marc S
MS
Jablonski
Kathleen A
KA
Rice
Madeline Murguia
MM
Hsia
Judith
J
Wergeland
Ragnhild
R
Landaas
Sverre
S
Rouleau
Jean L
JL
Domanski
Michael J
MJ
Hall
Christian
C
Pfeffer
Marc A
MA
Braunwald
Eugene
E
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
D000806:Angiotensin-Converting Enzyme Inhibitors; D015415:Biomarkers; D007211:Indoles; D020097:Natriuretic Peptide, Brain; C052035:trandolapril