Association of elevated B-type natriuretic peptide levels with angiographic findings among patients with unstable angina and non-ST-segment elevation myocardial infarction.

Abstract

OBJECTIVES:

We hypothesized that elevated B-type natriuretic peptide (BNP) levels would be associated with a greater severity of angiographic disease and a greater extent of myocardium at risk.

BACKGROUND:

Elevations of BNP have been associated with increased risk of adverse outcomes in patients with unstable angina and non-ST-segment elevation myocardial infarction (UA/NSTEMI).

METHODS:

Of the 2,220 patients with UA/NSTEMI enrolled in the Treat Angina with Aggrastat and Determine Cost of Therapy with an Invasive or Conservative Strategy-Thrombolysis In Myocardial Infarction-18 (TACTICS-TIMI-18) trial, 276 randomized to the invasive arm had both baseline BNP levels and angiographic core laboratory data. Patients were categorized according to their baseline BNP levels as < or =80 or >80 pg/ml.

RESULTS:

A total of 233 patients (84%) had BNP levels >80 pg/ml, and 43 (16%) had admission BNP levels >80 pg/ml. Patients with BNP >80 pg/ml had tighter culprit vessel stenosis on quantitative coronary angiography (median stenosis 76% vs. 67%, p = 0.004) and a higher (slower) corrected TIMI frame count (median CTFC 43 vs. 30, p = 0.018) in the culprit vessel. The median BNP level was higher in patients with a left anterior descending coronary artery (LAD) versus non-LAD culprit lesion location (median BNP level 40 vs. 24 pg/ml, p = 0.005), and the culprit artery was more often the LAD in patients with BNP >80 pg/ml compared with < or =80 pg/ml (44% vs. 30%, p = 0.06).

CONCLUSIONS:

Among patients with UA/NSTEMI, elevated BNP levels are associated with tighter culprit stenosis, higher CTFC, and LAD involvement. These findings suggest that elevated BNP may be associated with a greater severity and extent of myocardial ischemic territory during the index event and may partly explain the association between elevated BNP and adverse outcomes.

• Authors: Saihari Sadanandan, Christopher P Cannon, Kasi Chekuri, Sabina A Murphy, Peter M Dibattiste, David A Morrow, James A de Lemos, Eugene Braunwald, C Michael Gibson
• Journal: Journal of the American College of Cardiology (J Am Coll Cardiol) Vol. 44 Issue 3 Pg. 564-8 (Aug 04 2004) ISSN: 0735-1097 [Print] United States
• PMID: 15358021 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Biomarkers
• Natriuretic Peptide, Brain

Topics

• Aged
• Angina, Unstable (blood, diagnostic imaging, pathology)
• Biomarkers (blood)
• Coronary Angiography
• Female
• Heart Conduction System (physiopathology)
• Humans
• Male
• Middle Aged
• Myocardial Infarction (blood, diagnostic imaging, pathology, physiopathology)
• Natriuretic Peptide, Brain (blood)
• Severity of Illness Index