High levels of B-type natriuretic peptide (BNP) measured during acute coronary syndrome (ACS) strongly predict risk for death and incident congestive heart failure (CHF). To assess the prognostic value of BNP during follow-up of patients with ACS, these researchers used data from a multisite trial of a statin intervention.
Of 3493 patients, 13.5% had BNP concentrations higher than 80 pg/mL before hospital discharge (baseline), and 4.0% had persistent high levels at 4 months. Of those with normal baseline levels, 2.5% had elevated levels at 4 months. During 2 years of follow-up, 230 cardiac deaths and 163 cases of new-onset CHF occurred. After adjustment for other cardiac risk factors, patients with elevated baseline BNP levels were at significantly greater risk for death or new-onset CHF than those with lower levels (hazard ratio, 2.5); those with elevated levels at 4 months also were at greater risk than those with lower levels (HR, 3.9). Compared with patients with lower BNP at both visits, those with newly elevated BNP at 4 months had significantly greater risk (HR, 4.5), whereas those with high baseline levels that declined at 4 months had moderately increased risk (HR, 1.7).
These data extend previous findings showing an association between BNP levels during ACS and subsequent prognosis, and suggest that serial determinations of BNP could offer additional prognostic information.
Reference:
Morrow DA et al. Prognostic value of serial B-type natriuretic peptide testing during follow-up of patients with unstable coronary artery disease. JAMA 2005 Dec 14; 294:2866-71.