B-type natriuretic peptide and the risk of cardiovascular events and death in patients with stable angina -: Results from the AtheroGene study

OBJECTIVES The aim of this study was to assess the predictive value of the cardiac hormone B-type natriuretic peptide (BNP) for long-term outcome in a large cohort of stable angina patients. BACKGROUND Recent data suggest a role of BNP in stable ischemic heart disease beyond its known value in heart failure and acute coronary syndromes. METHODS In 1,085 patients with coronary artery disease (CAD) baseline levels of BNP were prospectively associated with cardiovascular (CV) events during a mean follow-up of 2.5 years. RESULTS BNP concentrations were significantly elevated in patients with future CV events (median [25th/75th interquartile range] 119.2 [43.6/300.4] pg/ml vs. 36.2 [11.3/94.6] pg/ml; p < 0.001). Kaplan-Meier survival analysis showed a stepwise decrease in event-free survival across quartiles of BNP baseline concentration (P-log (rand) < 0.001). Patients in the highest quartile revealed a 6.1-fold increased risk (p 0.001) compared to patients in the lowest quartile after adjustment for potential confounders. For a cut-off value of 100 pg/ml, an independently increased risk of adverse outcome (hazard ratio [HR] 4.4; p < 0.001) could be demonstrated. One standard deviation (SD) decrease in ejection fraction implied the most prominent increase in risk of future CV events (HR 1.69; p < 0.001) followed by one SD increase in BNP (HR 1.53; p < 0.001). The highest prognostic accuracy could be demonstrated for BNP (area under the curve 0.671). CONCLUSIONS The data of this large group of CAD patients provide independent evidence that BNP is a strong predictor of cardiovascular risk in patients with stable angina independent of left ventricular systolic performance and known risk factors.