TY - JOUR
T1 - Association of elevated B-type natriuretic peptide levels with angiographic findings among patients with unstable angina and non-ST-segment elevation myocardial infarction
AU - Sadanandan, Saihari
AU - Cannon, Christopher P.
AU - Chekuri, Kasi
AU - Murphy, Sabina A.
AU - Dibattiste, Peter M.
AU - Morrow, David A.
AU - de Lemos, James A
AU - Braunwald, Eugene
AU - Gibson, C. Michael
N1 - Funding Information:
The TACTICS-TIMI-18 trial was funded by Merck & Co. Drs. de Lemos and Morrow have received grant support from Biosite Inc., San Diego, California, the manufacturers of the Triage BNP test.
PY - 2004/8/4
Y1 - 2004/8/4
N2 - 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 ≤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 ≤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.
AB - 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 ≤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 ≤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.
KW - B-type natriuretic peptide
KW - BNP
KW - CAD
KW - CTFC
KW - LAD
KW - LV
KW - NSTEMI
KW - STEMI
KW - coronary artery disease
KW - corrected TIMI frame count
KW - left anterior descending coronary artery
KW - left ventricular
KW - non-ST-segment elevation myocardial infarction
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U2 - 10.1016/j.jacc.2004.03.072
DO - 10.1016/j.jacc.2004.03.072
M3 - Article
C2 - 15358021
AN - SCOPUS:4043152160
SN - 0735-1097
VL - 44
SP - 564
EP - 568
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 3
ER -