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B型利钠肽与稳定型心绞痛患者心血管事件和死亡的风险:来自AtheroGene研究的结果

B-type natriuretic peptide and the risk of cardiovascular events and death in patients with stable angina: Results from the AtheroGene study
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摘要 OBJECTIVES: The aim of this study was to assess the predictive value of the cardiac hormone B- type natriuretic peptide(BNP) for long- term outcome in a large cohort of stable angina patients. BACKGROUND: Recent data suggest a role of BNP in stable ischemic heart disease beyond its known value in heart failure and acute coronary syndromes. METHODS: In 1,085 patients with coronary artery disease(CAD) baseline levels of BNP were prospectively associated with cardiovascular(CV) events during a mean follow- up of 2.5 years. RESULTS: BNP concentrations were significantly elevated in patients with future CV events(median [25th/75th interquartile range] 119.2 [43.6/300.4] pg/ml vs. 36.2 [11.3/94.6] pg/ml; p< 0.001). Kaplan- Meier survival analysis showed a stepwise decrease in event- free survival across quartiles of BNP baseline concentration(plogrank< 0.001). Patients in the highest quartile revealed a 6.1- fold increased risk(p=0.001) compared to patients in the lowest quartile after adjustment for potential confounders. For a cut- off value of 100 pg/ml, an independently increased risk of adverse outcome(hazard ratio [HR] 4.4; p< 0.001) could be demonstrated. One standard deviation(SD) decrease in ejection fraction implied the most prominent increase in risk of future CV events(HR 1.69; p< 0.001) followed by one SD increase in BNP(HR 1.53; p< 0.001). The highest prognostic accuracy could be demonstrated for BNP(area under the curve 0.671). CONCLUSIONS: The data of this large group of CAD patients provide independent evidence that BNP is a strong predictor of cardiovascular risk in patients with stable angina independent of left ventricular systolic performance and known risk factors. OBJECTIVES: The aim of this study was to. assess the predictive value of the cardiac hormone B-type natriuretic peptide(BNP) for long-term outcome in a large cohort of stable angina patients. BACKGROUND: Recent data suggest a role of BNP in stable ischemic heart disease beyond its known value in heart failure and acute coronary syndromes. METHODS: In 1, 085 patients with coronary artery disease(CAD) baseline levels of BNP were prospectively associated with cardiovascular(CV) events during a mean follow-up of 2.5 years. RESULTS: BNP concentrations were significantly elevated in patients with future CV events(median [25th/75th interquartile range] 119.2 [43.6/300. 4] pg/ml vs. 36. 2 [11.3/94.6] pg/ ml; p 〈 0. 001). Kaplan-Meier survival analysis showed a stepwise decrease in event-free survival across quartiles of BNP baseline concentration(plogrank 〈 0. 001) . Patients in the highest quartile revealed a 6. 1-fold increased risk(p = 0. 001) compared to patients in the lowest quartile after adjustment for potential confounders. For a cut-off value of 100 pg/ml, an independently increased risk of adverse outcome(hasard ratio [HR] 4.4; p 〈 0.001) could be demonstrated.
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