title: Diagnostic implication of change in b-type natriuretic peptide (BNP) for prediction of subsequent target lesion revascularization following silorimus-eluting stent deployment.
abstract: BACKGROUND
  Restenosis after percutaneous coronary intervention (PCI) is still a great concern even in the recent drug-eluting stent (DES) era. As less invasive and sensitive parameter to detect restenosis is needed, this study was aimed to assess whether the clinical implication of temporal change in plasma BNP levels might be a useful indicator of restenosis after DES implantation.
  
  
  RESULTS
  847 consecutive patients who underwent elective PCI using silorimus-eluting sent (SES) between 2005 and 2009 were analyzed. Primary endpoint was subsequent target-lesion revascularization (TLR) after PCI. There was no significant difference in either baseline (TLR+vs. TLR-: 107.2 ± 172.2 vs. 96.2 ± 175.5 pg/mL, P=0.53) or follow-up plasma B-type natriuretic peptide (BNP) levels (TLR+vs. TLR-: 88.6 ± 111.6 vs. 68.5 ± 226.0 pg/mL, P=0.35) between patients with and without subsequent TLR. Conversely, ratio of follow-up to baseline BNP was significantly higher in patients with TLR (TLR+vs. TLR-: 1.55 ± 1.58 vs. 1.07 ± 1.04, P<0.001). Multivariate analysis using logistic regression showed log transformed BNP-ratio was an independent predictor of TLR (adjusted odds ratio (aOR): 1.94, 95%CI: 1.42-2.66, P<0.001). A closer relationship between BNP elevation greater than 2-fold and subsequent TLR was found (aOR: 2.69, 95%CI: 1.27-5.69, P<0.009). Furthermore, propensity score matching analysis showed that the incidence of subsequent TLR was significantly higher in patients with BNP elevation (P<0.001).
  
  
  CONCLUSIONS
  Serial measurement of plasma BNP levels and its change might be a useful approach to predict restenosis in patients without typical chest symptoms receiving SES.
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo 113-8611, Japan.
authors.forename: Eriko
authors.initials: E
authors.lastname: Hasumi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Iwata
authors.forename: Takahide
authors.initials: T
authors.lastname: Kohro
authors.forename: Ichiro
authors.initials: I
authors.lastname: Manabe
authors.forename: Koichiro
authors.initials: K
authors.lastname: Kinugawa
authors.forename: Naho
authors.initials: N
authors.lastname: Morisaki
authors.forename: Jiro
authors.initials: J
authors.lastname: Ando
authors.forename: Daigo
authors.initials: D
authors.lastname: Sawaki
authors.forename: Masao
authors.initials: M
authors.lastname: Takahashi
authors.forename: Hideo
authors.initials: H
authors.lastname: Fujita
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yamashita
authors.forename: Junya
authors.initials: J
authors.lastname: Ako
authors.forename: Yasunobu
authors.initials: Y
authors.lastname: Hirata
authors.forename: Issei
authors.initials: I
authors.lastname: Komuro
authors.forename: Ryozo
authors.initials: R
authors.lastname: Nagai
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D023903:Coronary Restenosis / Q000097:blood* / Q000175:diagnosis; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000379:methods*; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D020123:Sirolimus / Q000008:administration & dosage*
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain; D020123:Sirolimus
keywords: Biomarker; Drug-eluting stent; Plasma BNP; Restenosis