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CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY

Percutaneous Coronary Revascularization Reduces Plasma N-Terminal Pro-B-Type Natriuretic Peptide Concentration in Stable Coronary Artery Disease

Samuel J. McClure, MBChB, MRCP^_*, Scott Gall, MBChB, MRCP^_*, Clyde B. Schechter, MA, MD, FACPM, Mark Kearney, MBChB, MRCP, MD^,1 and Azfar G. Zaman, BSc, MBChB, MD, FRCP^_*,,2,_*

^_* Department of Cardiology, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom
Department of Family and Social Medicine, Albert Einstein College of Medicine of Yeshiva University, Bronx, New York
Department of Cardiovascular Science, Leeds University, Leeds, United Kingdom
Freeman Hospital and University of Newcastle, Newcastle-upon-Tyne, United Kingdom.

Manuscript received November 18, 2006; revised manuscript received February 7, 2007, accepted February 12, 2007.

^_* Reprint requests and correspondence: Dr. Azfar G. Zaman, Freeman Hospital and University of Newcastle, Newcastle-upon-Tyne, NE7 7DN, United Kingdom. (Email: azfar.zaman{at}nuth.nhs.uk).

Objectives: The purpose of this work was to assess the effect of percutaneous coronary revascularization (PCR) on plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentration.

Background: Left ventricular (LV) dysfunction is associated with increased plasma natriuretic peptide concentrations. The effect of ischemia resolution on plasma natriuretic peptide is not known.

Methods: Twenty-six patients with stable angina, normal LV systolic function, and isolated stenoses of the left anterior descending (LAD) coronary artery were studied. All patients had angiographically and physiologically significant lesions defined by cine-angiography and intracoronary pressure wire.

Results: After revascularization, 24 patients demonstrated significant decrease in mean plasma NT-proBNP 8 weeks after PCR (from 177.2 ± 190.8 pg/ml to 105.0 ± 92.4 pg/ml, p = 0.03). The mean decrease in log NT-proBNP was 0.533, corresponding to geometric mean decrease of NT-proBNP by a factor of 59% (95% confidence interval 48.2% to 71.4%, p < 0.00005). Reduction in NT-proBNP was independent of change in LV systolic function.

Conclusions: This study demonstrates that removal of fixed LAD stenosis reduces plasma NT-proBNP concentration. This has implications for interpretation of natriuretic peptide levels in clinical settings and as screening tool for LV systolic dysfunction.

Abbreviations and Acronyms   BNP = B-type natriuretic peptide   FFR = fractional flow reserve   LAD = left anterior descending artery   LV = left ventricular   NT-proBNP = N-terminal pro-B-type natriuretic peptide   PCR = percutaneous coronary revascularization

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