title: B-type natriuretic peptide as an independent predictor of coronary disease extension in non-ST elevation coronary syndromes with preserved systolic function.
abstract: OBJECTIVE
  B-type natriuretic peptide (BNP) has been employed as a risk marker in patients with coronary artery disease (CAD) with ST elevation and non-ST elevation. It is not yet established if early BNP measurements provide additional information to troponin and electrocardiographic analysis in patients without ventricular enlargement and systolic dysfunction.
  
  
  METHODS
  This study compared BNP levels in patients with stable angina (SA) and acute coronary syndromes with non-ST elevation in relation to angiographic lesions (NSTEMI-ACS). Moreover, the diagnostic utility of BNP was determined using the receiver operating characteristic curve.
  
  
  METHODS
  280 patients with CAD without ST elevation and preserved systolic function were studied. BNP samples were measured in all recruited patients within 24 hours of hospitalization.
  
  
  RESULTS
  BNP values increased progressively with the severity of diagnosis: SA (n = 85; 50.4 ± 50 pg/ml) NSTEMI-ACS (n = 195; 283 ± 269 pg/ml; p < 0.0001). The analysis of BNP in relation to the number of involved vessels demonstrated significantly increased levels in patients with multivessel disease compared to patients with 1- or 2-vessel disease (p < 0.001 and p < 0.003). Values of BNP >80 pg/ml were shown to be able to predict CAD severity and coronary vessel involvement (AUC = 0.80; p = 0.0001) with a sensitivity of 78% and a specificity of 72%. In multivariate analysis, BNP levels >80 pg/ml, CAD history, and ST deviation >2 mm were confirmed as independent predictors of CAD severity.
  
  
  CONCLUSIONS
  Circulating BNP levels appear elevated in NSTEMI-ACS, without left ventricular systolic dysfunction. A BNP cut-off value of 80 pg/ml is a good predictor of CAD extension.
authors.affiliation: Department of Internal Medicine and Metabolic Disease Cardiology Section, University of Siena, Italy. palazzuoli2@unisi.it
authors.forename: Alberto
authors.initials: A
authors.lastname: Palazzuoli
authors.forename: Maria
authors.initials: M
authors.lastname: Caputo
authors.forename: Massimo
authors.initials: M
authors.lastname: Fineschi
authors.forename: Romina
authors.initials: R
authors.lastname: Navarri
authors.forename: Anna
authors.initials: A
authors.lastname: Calabrò
authors.forename: Matteo
authors.initials: M
authors.lastname: Cameli
authors.forename: Maria Stella
authors.initials: MS
authors.lastname: Campagna
authors.forename: Beatrice
authors.initials: B
authors.lastname: Franci
authors.forename: Carlo
authors.initials: C
authors.lastname: Pierli
authors.forename: Ranuccio
authors.initials: R
authors.lastname: Nuti
authors.forename: Alan
authors.initials: A
authors.lastname: Maisel
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology; D000368:Aged; D060050:Angina, Stable / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology; D015415:Biomarkers / Q000097:blood; D017023:Coronary Angiography; D003327:Coronary Disease / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007558:Italy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013599:Systole; D015854:Up-Regulation; D016277:Ventricular Function, Left
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain