Abstract 17669: Change in Levels Of B-Type Natriuretic Peptide (BNP) During Follow up Predicts in Stent Restenosis After Drug-Eluting Stent (DES) Implantation
Background: Advent of drug-eluting stents (DES) has contributed to reduce need for repeat revascularization. However, in-stent restenosis (ISR) is still of great concern particularly in patients with complex background. However, as coronary angiogram might be invasive and no marker has been established for prediction of ISR, a non-invasive and specific parameter has been required. The aim of this study is to evaluate the usefulness of change in plasma BNP level after PCI for prediction of prognosis of lesions.
Methods and Patients: The study group consisted of 1435 lesions in 709 consecutive patients with stable angina pectoris who had undergone elective PCI using DES between January 2005 and December 2008, whose baseline and follow-up data of both angiography and plasma BNP were available. All clinical data was retrospectively collected as the institutional database (University of Tokyo Catheter Database System; UT-CDS). Primary end point used in this study was target-lesion revascularization (TLR) within 500 days after PCI.
Results: Sirolimus-eluting stents (SES) were used for 89.6% of lesions and paclitaxel-eluting stents (PES) for 10.9% and 181 lesions (12.6%) of 64 patients (9.0%) underwent TLR. PES was more frequently used in TLR+ group (TLR+ vs. TLR-: 20.6% vs. 9.6%, p<0.001). Although there was no significant difference in both baseline (TLR+ vs. TLR-: 232±391 vs. 169±342 pg/mL, p=0.07) and follow-up plasma BNP levels among groups, ratio of follow-up to baseline BNP was higher in TLR+ group (TLR+ vs. TLR-: 1.58±1.46 vs. 0.98±0.89, p<0.001). Multivariate analysis using Cox-proportional-hazard regression model showed BNP elevation was an independent predictor of TLR (Hazard ratio 2.19, 95%CI 1.31-3.64, p<0.001), while low ejection fraction (EF40%), AUC of ROC curve of BNP ratio for TLR was 0.78 (p<0.001), and optimal cutoff level was 0.90.
Conclusions: Change in BNP level during follow up might be a non-invasive and useful indicator of restenosis after DES implantation.
- © 2010 by American Heart Association, Inc.