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(Circulation. 2005;112:2102-2107.)
© 2005 American Heart Association, Inc.

Coronary Heart Disease

Prognostic Value of N-Terminal Pro–Brain Natriuretic Peptide in Patients With Chronic Stable Angina

Gjin Ndrepepa, MD; Siegmund Braun, MD; Kathrin Niemöller, MD; Julinda Mehilli, MD; Nicolas von Beckerath, MD; Olga von Beckerath, MD; Wolfgang Vogt, MD; Albert Schömig, MD; Adnan Kastrati, MD

From the Klinik für Herz- und Kreislauferkrankungen (G.N., K.N., J.M., N.v.B., O.v.B., A.S., A.K.) und Institut für Laboratoriumsmedizin (S.B., W.V.), Deutsches Herzzentrum München and 1 Medizinische Klinik Klinikum rechts der Isar (A.S.), Technische Universität München, Munich, Germany.

Correspondence to Adnan Kastrati, MD, Deutsches Herzzentrum, Lazarettstrasse 36, 80636 München, Germany. E-mail kastrati{at}dhm.mhn.de

Received October 14, 2004; de novo received March 21, 2005; revision received June 29, 2005; accepted July 6, 2005.

Background— Patients with chronic stable angina are poorly characterized in terms of biomarkers that help in the assessment of prognosis. We investigated whether plasma levels of N-terminal pro–brain natriuretic peptide (NT-proBNP) may be used as a prognostic marker in patients with chronic stable angina treated with coronary stenting.

Methods and Results— Plasma levels of NT-proBNP were measured in 1059 patients with chronic stable angina and coronary angiographic confirmation of significant coronary artery disease. The primary end point of the study was mortality. After a median of 3.6 years (interquartile range, 3.3 to 4.5 years), there were 106 deaths. Kaplan-Meier estimates of 5-year mortality were 4.7% in the first quartile, 7.8% in the second quartile, 11.4% in the third quartile, and 32.7% in the fourth quartile of NT-proBNP (P<0.001). A Cox proportional hazards model showed that NT-proBNP was the strongest correlate of mortality (adjusted hazards ratio [HR], 5.83 [95% confidence interval: 2.07 to 16.44] for the fourth versus the first quartile). A similar prognostic value of NT-proBNP was demonstrated for cardiovascular mortality (HR, 5.98 [1.55 to 23.13] for the fourth versus the first quartile) and for patients with New York Heart Association class I and II (HR, 6.03 [2.07 to 17.52] for the fourth versus the first quartile).

Conclusions— Circulating levels of NT-proBNP are a strong prognostic biomarker for patients with chronic stable angina.

Key Words: angina • mortality • natriuretic peptides • prognosis

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