Coronary artery disease| Volume 95, ISSUE 1, P24-28, January 01, 2005

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B-type natriuretic peptide and long-term survival in patients with stable coronary artery disease

      Circulating B-type natriuretic peptide (BNP) is a strong predictor of survival in patients with acute coronary syndromes and in patients with congestive heart failure. Whether circulating BNP levels are predictive of long-term survival in patients with angiographically documented, clinically stable coronary artery disease is unknown. We studied 186 patients with stable angina pectoris and angiographic evidence of significant coronary artery disease. Patients with a recent myocardial infarction, electrocardiographic evidence of ongoing ischemia, anginal pain at rest, or symptomatic congestive heart failure were excluded from the study. During a follow-up of 7.4 years, 23 patients died. By Cox proportional-hazards regression, patient age (p = 0.031), pathologic Q waves on the electrocardiogram (p = 0.037), left ventricular ejection fraction (p = 0.016), and plasma BNP (p = 0.008) were significantly associated with long-term survival. In a stepwise forward multivariate model, BNP (p = 0.005) provided prognostic information above and beyond conventional risk markers. In patients with clinically stable, angiographically documented coronary artery disease, plasma BNP levels are independently related to long-term survival.
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        • Omland T.
        • Aakvaag A.
        • Bonarjee V.V.S.
        • Caidahl K.
        • Lie R.T.
        • Nilsen D.W.
        • Sundsfjord J.A.
        • Dickstein K.
        Plasma brain natriuretic peptide as an indicator of left ventricular systolic function and long-term prognosis after acute myocardial infarction.
        Circulation. 1996; 93: 1963-1969
        • de Lemos J.A.
        • Morrow D.A.
        • Bentley J.H.
        • Omland T.
        • Sabatine M.S.
        • McCabe C.H.
        • Hall C.
        • Cannon C.P.
        • Braunwald E.
        The prognostic value of B-type natriuretic peptide in patients with acute coronary syndromes.
        N Engl J Med. 2001; 345: 1014-1021
        • Richards A.M.
        • Nicholls M.G.
        • Espiner E.A.
        • Laincbury J.G.
        • Troughton R.W.
        • Delliott J.
        • Frampton C.
        • Turner J.
        • Crozier I.A.
        • Yandle T.G.
        B-type natriuretic peptides and ejection fraction for prognosis after myocardial infarction.
        Circulation. 2003; 107: 2786-2792
        • Omland T.
        • Persson A.
        • Ng L.
        • O'Brien R.
        • Karlsson T.
        • Herlitz J.
        • Hartford M.
        • Caidahl K.
        N-terminal pro-B-type natriuretic peptide and long-term mortality in acute coronary syndromes.
        Circulation. 2002; 106: 2913-2918
        • James S.K.
        • Lindahl B.
        • Siegbahn A.
        • Stridsberg M.
        • Venge P.
        • Armstrong P.
        • Barnathan E.S.
        • Califf R.
        • Topol E.J.
        • Simoons M.L.
        • Wallentin L.
        N-terminal pro-brain natriuretic peptide and other risk markers for the separate prediction of mortality and subsequent myocardial infarction in patients with unstable coronary artery disease: a Global Utilization of Stratgies To Open occluded arteries (GUSTO-IV) substudy.
        Circulation. 2003; 108: 275-281
        • Wang T.J.
        • Larson M.G.
        • Levy D.
        • Benjamin E.J.
        • Leip E.P.
        • Omland T.
        • Wolf P.A.
        • Vasan R.S.
        Plasma natriuretic peptide levels and the risk of cardiovascular events and death.
        N Engl J Med. 2004; 350: 655-663
        • Ridker P.M.
        • Rifai N.
        • Pfeffer M.A.
        • Sacks F.M.
        • Moye L.A.
        • Goldman S.
        • Flaker G.C.
        • Braunwald E.
        Inflammation, pravastatin and the risk of coronary events after myocardial infarction in patients with average cholesterol levels.
        Circulation. 1998; 98: 839-844
        • Omland T.
        • Aakvaag A.
        • Vik-Mo H.
        Plasma cardiac natriuretic peptide determination as a screening test for the detection of patients with mild left ventricular impairment.
        Heart. 1996; 76: 232-237
        • Yandle T.G.
        • Richards A.M.
        • Gilbert A.
        • Fisher S.
        • Holmes S.
        • Espiner E.A.
        Assay of brain natriuretic peptide (BNP) in human plasma: evidence for high molecular weight BNP as a major plasma component in heart failure.
        J Clin Endocrinol Metab. 1993; 76: 832-838
        • Tsutamoto T.
        • Wada A.
        • Maeda K.
        • Hisanaga T.
        • Maeda K.
        • Fukai D.
        • Ohnishi M.
        • Sugimoto Y.
        • Kinoshita M.
        Attenuation of compensation of endogenous cardiac natriuretic peptide system in chronic heart failure: prognostic role of plasma brain natriuretic peptide concentration in patients with chronic symptomatic left ventricular dysfunction.
        Circulation. 1997; 96: 509-516
        • Anand I.S.
        • Fisher L.D.
        • Chiang Y.T.
        • Latini R.
        • Masson S.
        • Maggioni A.P.
        • Glazer R.D.
        • Tognoni G.
        • Cohn J.N.
        Changes in brain natriuretic peptide and norepinephrine over time and mortality and morbidity in the Valsartan Heart Failure Trial (Val-HeFT).
        Circulation. 2003; 107: 1278-1283
        • Wallen T.
        • Landahl S.
        • Hedner T.
        • Nakao K.
        • Saito Y.
        Brain natriuretic peptide predicts mortality in the elderly.
        Heart. 1997; 77: 264-267
        • McDonagh T.A.
        • Cunningham A.D.
        • Morrison C.E.
        • McMurray J.J.
        • Ford I.
        • Morton J.J.
        • Dargie H.J.
        Left ventricular dysfunction, natriuretic peptides, and mortality in an urban population.
        Heart. 2001; 86: 21-26
        • Kyriakides Z.
        • Markianos M.
        • Michalis L.
        • Antoniadis A.
        • Nikolaou N.I.
        • Kremastinos D.T.
        Brain natriuretic peptide increases acutely and much more prominently than atrial natriuretic peptide during coronary angioplasty.
        Clin Cardiol. 2000; 23: 285-288
        • Tateishi J.
        • Masutani M.
        • Ohyanagi M.
        • Iwasaki T.
        Transient increase in plasma brain (B-type) natriuretic peptide after percutaneous transluminal coronary angioplasty.
        Clin Cardiol. 2000; 23: 776-780
        • Marumoto K.
        • Hamada M.
        • Hiwada K.
        Increased secretion of atrial and brain natriuretic peptide during acute myocardial iscaemia induced by dynamic exercise in patients with angina pectoris.
        Clin Sci. 1995; 88: 551-556
        • Bibbins-Domingo K.
        • Ansari M.
        • Schiller N.B.
        • Massie B.
        • Whooley M.A.
        B-type natriuretic peptide and ischemia in patients with stable coronary artery disease.
        Circulation. 2003; 108: 2987-2992