B-type natriuretic peptide trumps other prognostic markers in patients assessed for coronary disease
© 2019 The Author(s). Background: Risk prediction for patients with suspected coronary artery disease is complex due to the common occurrence of prior cardiovascular disease and extensive risk modification in primary care. Numerous markers have the potential to predict prognosis and guide management...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Journal Article |
| Language: | English |
| Published: |
BMC
2019
|
| Subjects: | |
| Online Access: | http://hdl.handle.net/20.500.11937/80067 |
| _version_ | 1848764154104512512 |
|---|---|
| author | Kotecha, D. Flather, M.D. Atar, D. Collins, P. Pepper, J. Jenkins, E. Reid, Christopher Eccleston, D. |
| author_facet | Kotecha, D. Flather, M.D. Atar, D. Collins, P. Pepper, J. Jenkins, E. Reid, Christopher Eccleston, D. |
| author_sort | Kotecha, D. |
| building | Curtin Institutional Repository |
| collection | Online Access |
| description | © 2019 The Author(s). Background: Risk prediction for patients with suspected coronary artery disease is complex due to the common occurrence of prior cardiovascular disease and extensive risk modification in primary care. Numerous markers have the potential to predict prognosis and guide management, but we currently lack robust 'real-world' evidence for their use. Methods: Prospective, multicentre observational study of consecutive patients referred for elective coronary angiography. Clinicians were blinded to all risk assessments, consisting of conventional factors, radial artery pulse wave analysis, 5-minute heart rate variability, high-sensitivity C-reactive protein and B-type natriuretic peptide (BNP). Blinded, independent adjudication was performed for all-cause mortality and the composite of death, myocardial infarction or stroke, analysed with Cox proportional hazards regression. Results: Five hundred twenty-two patients were assessed with median age 66 years and 21% prior revascularization. Median baseline left ventricular ejection fraction was 64%, and 62% had ≥ 50% stenosis on angiography. During 5.0 years median follow-up, 30% underwent percutaneous and 16% surgical revascularization. In multivariate analysis, only age and BNP were independently associated with outcomes. The adjusted hazard ratio per log unit increase in BNP was 2.15 for mortality (95% CI 1.45-3.19; p = 0.0001) and 1.27 for composite events (1.04-1.54; p = 0.018). Patients with baseline BNP > 100 pg/mL had substantially higher mortality and composite events (20.9% and 32.2%) than those with BNP ≤ 100 pg/mL (5.6% and 15.5%). BNP improved both classification and discrimination of outcomes (p ≤ 0.003), regardless of left ventricular systolic function. Conversely, high-sensitivity C-reactive protein, pulse wave analysis and heart rate variability were unrelated to prognosis at 5 years after risk modification and treatment of coronary disease. Conclusions: Conventional risk factors and other markers of arterial compliance, inflammation and autonomic function have limited value for prediction of outcomes in risk-modified patients assessed for coronary disease. BNP can independently identify patients with subtle impairment of cardiac function that might benefit from more intensive management. Trial registration: Clinicaltrials.gov, NCT00403351 Registered on 22 November 2006 |
| first_indexed | 2025-11-14T11:14:50Z |
| format | Journal Article |
| id | curtin-20.500.11937-80067 |
| institution | Curtin University Malaysia |
| institution_category | Local University |
| language | English |
| last_indexed | 2025-11-14T11:14:50Z |
| publishDate | 2019 |
| publisher | BMC |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | curtin-20.500.11937-800672021-01-05T08:07:08Z B-type natriuretic peptide trumps other prognostic markers in patients assessed for coronary disease Kotecha, D. Flather, M.D. Atar, D. Collins, P. Pepper, J. Jenkins, E. Reid, Christopher Eccleston, D. Science & Technology Life Sciences & Biomedicine Medicine, General & Internal General & Internal Medicine Risk Mortality Coronary artery disease Coronary angiography B-type natriuretic peptide HEART-RATE-VARIABILITY CARDIOVASCULAR-DISEASE MYOCARDIAL-INFARCTION RISK-FACTORS MORTALITY EVENTS DEATH PREDICTION PRESSURE FAILURE © 2019 The Author(s). Background: Risk prediction for patients with suspected coronary artery disease is complex due to the common occurrence of prior cardiovascular disease and extensive risk modification in primary care. Numerous markers have the potential to predict prognosis and guide management, but we currently lack robust 'real-world' evidence for their use. Methods: Prospective, multicentre observational study of consecutive patients referred for elective coronary angiography. Clinicians were blinded to all risk assessments, consisting of conventional factors, radial artery pulse wave analysis, 5-minute heart rate variability, high-sensitivity C-reactive protein and B-type natriuretic peptide (BNP). Blinded, independent adjudication was performed for all-cause mortality and the composite of death, myocardial infarction or stroke, analysed with Cox proportional hazards regression. Results: Five hundred twenty-two patients were assessed with median age 66 years and 21% prior revascularization. Median baseline left ventricular ejection fraction was 64%, and 62% had ≥ 50% stenosis on angiography. During 5.0 years median follow-up, 30% underwent percutaneous and 16% surgical revascularization. In multivariate analysis, only age and BNP were independently associated with outcomes. The adjusted hazard ratio per log unit increase in BNP was 2.15 for mortality (95% CI 1.45-3.19; p = 0.0001) and 1.27 for composite events (1.04-1.54; p = 0.018). Patients with baseline BNP > 100 pg/mL had substantially higher mortality and composite events (20.9% and 32.2%) than those with BNP ≤ 100 pg/mL (5.6% and 15.5%). BNP improved both classification and discrimination of outcomes (p ≤ 0.003), regardless of left ventricular systolic function. Conversely, high-sensitivity C-reactive protein, pulse wave analysis and heart rate variability were unrelated to prognosis at 5 years after risk modification and treatment of coronary disease. Conclusions: Conventional risk factors and other markers of arterial compliance, inflammation and autonomic function have limited value for prediction of outcomes in risk-modified patients assessed for coronary disease. BNP can independently identify patients with subtle impairment of cardiac function that might benefit from more intensive management. Trial registration: Clinicaltrials.gov, NCT00403351 Registered on 22 November 2006 2019 Journal Article http://hdl.handle.net/20.500.11937/80067 10.1186/s12916-019-1306-9 English http://creativecommons.org/licenses/by/4.0/ BMC fulltext |
| spellingShingle | Science & Technology Life Sciences & Biomedicine Medicine, General & Internal General & Internal Medicine Risk Mortality Coronary artery disease Coronary angiography B-type natriuretic peptide HEART-RATE-VARIABILITY CARDIOVASCULAR-DISEASE MYOCARDIAL-INFARCTION RISK-FACTORS MORTALITY EVENTS DEATH PREDICTION PRESSURE FAILURE Kotecha, D. Flather, M.D. Atar, D. Collins, P. Pepper, J. Jenkins, E. Reid, Christopher Eccleston, D. B-type natriuretic peptide trumps other prognostic markers in patients assessed for coronary disease |
| title | B-type natriuretic peptide trumps other prognostic markers in patients assessed for coronary disease |
| title_full | B-type natriuretic peptide trumps other prognostic markers in patients assessed for coronary disease |
| title_fullStr | B-type natriuretic peptide trumps other prognostic markers in patients assessed for coronary disease |
| title_full_unstemmed | B-type natriuretic peptide trumps other prognostic markers in patients assessed for coronary disease |
| title_short | B-type natriuretic peptide trumps other prognostic markers in patients assessed for coronary disease |
| title_sort | b-type natriuretic peptide trumps other prognostic markers in patients assessed for coronary disease |
| topic | Science & Technology Life Sciences & Biomedicine Medicine, General & Internal General & Internal Medicine Risk Mortality Coronary artery disease Coronary angiography B-type natriuretic peptide HEART-RATE-VARIABILITY CARDIOVASCULAR-DISEASE MYOCARDIAL-INFARCTION RISK-FACTORS MORTALITY EVENTS DEATH PREDICTION PRESSURE FAILURE |
| url | http://hdl.handle.net/20.500.11937/80067 |