Usefulness of Serum N-Terminal Pro–Brain Natriuretic Peptide to Predict In-Stent Restenosis in Patients With Preserved Left Ventricular Function and Normal Troponin I Levels

      The level of N-terminal pro–B-type natriuretic peptide (NT–pro-BNP) is a strong predictor of mortality in patients with acute coronary syndrome and may be a strong prognostic marker in patients with chronic coronary artery disease. We investigated whether NT–pro-BNP could predict in-stent restenosis (ISR) in asymptomatic patients with preserved left ventricular (LV) systolic function who underwent percutaneous coronary intervention. We measured serum NT–pro-BNP levels in 249 patients (61 ± 9 years of age; 73% men) with preserved LV systolic function (ejection fraction >50%) who underwent follow-up coronary angiography. Initial diagnoses were stable angina in 50 (20%), unstable angina in 133 (53%), and myocardial infarction in 66 (27%). Baseline characteristics between groups with ISR (n = 92) and without ISR (n = 157) were similar. The level of NT–pro-BNP was higher in patients with ISR than in those without ISR (222 ± 327 vs 94 ± 136 pg/ml, p = 0.001). In the ISR group, NT–pro-BNP level was higher in patients with left anterior descending coronary artery ISR (n = 53, 312 ± 479 pg/ml) than in those with left circumflex coronary artery ISR (n = 19, 115 ± 98 pg/ml, p = 0.018). At the standard cutoff of >200 pg/ml, a high NT–pro-BNP level indicated a high probability of ISR (odds ratio 2.18, 95% confidence interval 1.0 to 4.5, p = 0.038). In multivariate analysis, NT–pro-BNP level was an independent predictor for ISR. In conclusion, NT–pro-BNP could be a predictor of ISR in asymptomatic patients with preserved LV systolic function.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • 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.
        Circulation. 2003; 108: 275-281
        • Nishikimi T.
        • Matsuoka H.
        Are plasma levels of atrial natriuretic peptide, N-terminal ProANP, and brain natriuretic peptide affected by the presence of coronary artery disease?.
        Circulation. 2004; 109: e331
        • Lindahl B.
        • Lindback J.
        • Jernberg T.
        • Johnston N.
        • Stridsberg M.
        • Venge P.
        • Wallentin L.
        Serial analyses of N-terminal pro–B-type natriuretic peptide in patients with non–ST-segment elevation acute coronary syndromes: a Fragmin and fast Revascularisation during In Stability in Coronary artery disease (FRISC)-II substudy.
        J Am Coll Cardiol. 2005; 45: 533-541
        • Kalra P.R.
        • Gomma A.
        • Daly C.
        • Claque J.R.
        • Squire I.B.
        • Nq L.L.
        • Fox K.F.
        Reduction in plasma concentrations of N terminal pro B type natriuretic peptide following percutaneous coronary intervention.
        Heart. 2004; 90: 1334-1335
        • Hong S.N.
        • Yoon N.S.
        • Ahn Y.
        • Lim S.Y.
        • Kim Y.S.
        • Yun K.H.
        • Kang D.K.
        • Lee S.H.
        • Lee Y.S.
        • Kim K.H.
        • et al.
        N-terminal pro–B-type natriuretic peptide predicts significant coronary artery lesion in the unstable angina patients with normal electrocardiogram, echocardiogram, and cardiac enzymes.
        Circ J. 2005; 12: 1472-1476
        • Nilsson J.C.
        • Groenning B.A.
        • Nielsen G.
        • Fritz-Hansen T.
        • Trawinski J.
        • Hildebrandt P.R.
        • Jensen G.B.
        • Larsson H.B.
        • Sondergaard L.
        Left ventricular remodeling in the first year after acute myocardial infarction and the predictive value of N-terminal pro brain natriuretic peptide.
        Am Heart J. 2002; 143: 696-702
        • Hirayama A.
        • Kusuoka H.
        • Yamamoto H.
        • Sakata Y.
        • Asakura M.
        • Higuchi Y.
        • Mizuno H.
        • Kashiwase K.
        • Ueda Y.
        • Okuyama Y.
        • Hori M.
        • Kodama K.
        Usefulness of plasma brain natriuretic peptide concentration for predicting subsequent left ventricular remodeling after coronary angioplasty in patients with acute myocardial infarction.
        Am J Cardiol. 2006; 98: 453-457
        • Dong S.J.
        • de las Fuentes L.
        • Brown A.L.
        • Waggoner A.D.
        • Ewald G.A.
        • Davila-Roman V.G.
        N-terminal pro B-type natriuretic peptide levels: correlation with echocardiographically determined left ventricular diastolic function in an ambulatory cohort.
        J Am Soc Echocardiogr. 2006; 19: 1017-1025
        • Joung B.
        • Ha J.W.
        • Ko Y.G.
        • Kang S.M.
        • Rim S.J.
        • Jang Y.
        • Chung N.
        • Shim W.H.
        • Cho S.Y.
        Can pro–brain natriuretic peptide be used as a noninvasive predictor of elevated left ventricular diastolic pressures in patients with normal systolic function?.
        Am Heart J. 2005; 150: 1213-1219