B-type natriuretic peptide as an independent predictor of coronary disease extension in non-ST elevation coronary syndromes with preserved systolic function.

OBJECTIVE: B-type natriuretic peptide (BNP) has been employed as a risk marker in patients with coronary artery disease (CAD) with ST elevation and non-ST elevation. It is not yet established if early BNP measurements provide additional information to troponin and electrocardiographic analysis in patients without ventricular enlargement and systolic dysfunction. DESIGN: This study compared BNP levels in patients with stable angina (SA) and acute coronary syndromes with non-ST elevation in relation to angiographic lesions (NSTEMI-ACS). Moreover, the diagnostic utility of BNP was determined using the receiver operating characteristic curve. PATIENTS: 280 patients with CAD without ST elevation and preserved systolic function were studied. BNP samples were measured in all recruited patients within 24 hours of hospitalization. RESULTS: BNP values increased progressively with the severity of diagnosis: SA (n?=?85; 50.4?±?50?pg/ml) NSTEMI-ACS (n?=?195; 283?±?269?pg/ml; p?<?0.0001). The analysis of BNP in relation to the number of involved vessels demonstrated significantly increased levels in patients with multivessel disease compared to patients with 1- or 2-vessel disease (p?<?0.001 and p?<?0.003). Values of BNP >80?pg/ml were shown to be able to predict CAD severity and coronary vessel involvement (AUC?=?0.80; p?=?0.0001) with a sensitivity of 78% and a specificity of 72%. In multivariate analysis, BNP levels >80?pg/ml, CAD history, and ST deviation >2?mm were confirmed as independent predictors of CAD severity. CONCLUSIONS: Circulating BNP levels appear elevated in NSTEMI-ACS, without left ventricular systolic dysfunction. A BNP cut-off value of 80?pg/ml is a good predictor of CAD extension.