Abstract 13874: N Terminal Pro-Brain Natriuretic Peptide Levels and Benefits of Chronic Total Occlusion Revascularization

• Published in: Circulation (New York, N.Y.) Vol. 148; no. Suppl_1; p. A13874
• Main Authors: Gold, Daniel A, Sandesara, Pratik B, Jain, Vardhmaan, Gold, Matthew E, Vatsa, Nishant, Desai, Shivang, Elhage Hassan, Malika, Yuan, Chenyang, Ko, Yi-An, Liu, Chang, Ejaz, Kiran, Alvi, Zain N, Alkhoder, Ayman, Rahbar, Alireza, Murtagh, Gillian, Varounis, Christos, Jaber, Wissam, Nicholson, William, Quyyumi, Arshed A
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 07.11.2023
• Subjects: Biomarkers; Quality of medical care; Coronary interventions; Coronary artery disease; Outcomes
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/circ.148.suppl_1.13874

Background: The management of chronic total occlusion (CTO) remains a subject of debate, as the mortality benefit from revascularization remains controversial. Whether specific populations gain a survival benefit from CTO revascularization remains unknown. Purpose: In this prospective study of patients with stable coronary artery disease (CAD), we investigated whether patients with CTO have higher adverse event rates and higher N terminal pro-brain natriuretic peptide (NT pro-BNP) levels than patients without CTO. We also investigated whether a higher NT pro-BNP level predicts adverse events in patients with CTO and whether those with elevated NT pro-BNP levels have a survival benefit from revascularization. Methods: In 2,253 patients with significant CAD (>50% coronary luminal stenosis) undergoing cardiac catheterization, all-cause mortality, cardiovascular mortality and the composite of cardiovascular death, myocardial infarction and heart failure hospitalization rates were evaluated. Unadjusted and adjusted Cox proportional and Fine and Gray sub-distribution hazard models were performed to determine the association between NT pro-BNP level and event rates. Results: Patients with CTO had higher incident event rates by > 20% and had higher NT pro-BNP levels than those without CTO (median 230.0 vs. 177.7 pg/mL, p=<0.001). In patients with CTO, every doubling of NT pro-BNP level was associated with > 25% greater risk of adverse events. In patients with elevated NT pro-BNP level (> 125 pg/mL), CTO revascularization was associated with >50% lower adverse event rates than those without CTO revascularization (adjusted cardiovascular death hazard ratio 0.24, 95% confidence interval 0.07 - 0.81). Among patients with low NT pro-BNP level (< 125 pg/mL), event rates were similar in those with and without CTO revascularization. Conclusion: Patients with CTO have higher adverse event rates than those with significant CAD without CTO. NT pro-BNP levels are higher in patients with CTO and higher levels portend a worse prognosis. Moreover, NT pro-BNP levels can help identify individuals who may benefit from CTO revascularization.