CLINICAL RESEARCH
Association of elevated B-type natriuretic peptide levels with angiographic findings among patients with unstable angina and non–ST-segment elevation myocardial infarction
Saihari Sadanandan, MD*,*,
Christopher P. Cannon, MD ,
Kasi Chekuri, MD*,
Sabina A. Murphy, MPH,
Peter M. DiBattiste, MD ,
David A. Morrow, MD, MPH,
James A. de Lemos, MD ,
Eugene Braunwald, MD and
C. Michael Gibson, MS, MD
* Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma, USA
TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, and Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
Merck & Co., West Point, Pennsylvania, USA
Donald W. Reynolds Cardiovascular Clinical Research Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
Manuscript received January 16, 2004;
revised manuscript received March 24, 2004,
accepted March 29, 2004.
* Reprint requests and correspondence: Dr. Saihari Sadanandan, Beth Israel Deaconess Medical Center, Division of Cardiology, Harvard Medical School, One Deaconess Road, Baker 4, Boston, Massachusetts 02215, USA.
ssadanan{at}bidmc.harvard.edu
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.
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Abbreviations and Acronyms
| | BNP | = B-type natriuretic peptide | | CAD | = coronary artery disease | | CTFC | = corrected TIMI frame count | | LAD | = left anterior descending coronary artery | | LV | = left ventricular | | NSTEMI | = non–ST-segment elevation myocardial infarction | | STEMI | = ST-segment elevation myocardial infarction | | TACTICS–TIMI-18 | = Treat Angina with Aggrastat and Determine Cost of Therapy with an Invasive or Conservative Strategy–Thrombolysis In Myocardial Infarction-18 trial | | UA | = unstable angina |
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