N-terminal pro-brain natriuretic peptide used for the prediction of coronary artery stenosis

• Published in: European journal of clinical investigation Vol. 37; no. 1; pp. 18 - 25
• Main Authors: Wolber, T., Maeder, M., Rickli, H., Riesen, W., Binggeli, C., Duru, F., Ammann, P.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.01.2007
• Subjects: Aged; Biomarkers - blood; Coronary Angiography - methods; Coronary artery disease; Coronary Stenosis - diagnosis; diagnosis; Exercise Test - standards; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain - blood; natriuretic peptides; Peptide Fragments - blood; Predictive Value of Tests; stress test
• ISSN: 0014-2972; 1365-2362
• DOI: 10.1111/j.1365-2362.2007.01731.x

Background  The level of the inactive N‐terminal fragment of pro‐brain (B‐type) natriuretic peptide (NT‐proBNP) is a prognostic marker in patients with acute and chronic coronary artery disease (CAD). It might also be valuable for non‐invasive diagnosis of coronary artery disease. Materials and methods  The NT‐proBNP was measured in 781 consecutive patients with normal left ventricular function referred for coronary angiography owing to symptoms or signs of CAD. The diagnostic value of NT‐proBNP was assessed for predicting CAD at angiography. Results  Elevated NT‐proBNP levels were associated with the extent of CAD and with the female sex (P < 0·001). The ability of NT‐proBNP to predict significant coronary disease at angiography was assessed separately for men using a cut‐off point of 85 pg mL−1, positive likelihood ratio 2·2 (95% CI, 1·7–3·0), negative likelihood ratio 0·53 (95% CI 0·45–0·63) and area under the receiver‐operating‐characteristic (ROC) curve 0·72: for women, it was assessed using a cut‐off point of 165 pg mL−1, positive likelihood ratio 2·4 (95% CI, 1·7–3·4), negative likelihood ratio 0·55 (95% CI, 0·44–0·70) and area under ROC curve 0·71. In multiple logistic‐regression analysis, NT‐proBNP added significant independent predictive power to other clinical variables in models predicting CAD (odds ratio 2·76, 95% CI, 1·76–4·32, P < 0·001). Conclusions  The NT‐proBNP is a marker of non‐obstructive CAD and of significant coronary stenosis. In conjunction with other clinical information, measurement of NT‐proBNP with the use of sex‐specific reference ranges may improve the non‐invasive prediction of CAD.