Prognostic Value of Serial B-Type Natriuretic Peptide Testing During Follow-up of Patients With Unstable Coronary Artery Disease

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Abstract
B-type natriuretic peptide (BNP) is released from cardiac myocytes in response to increased wall stress,1 and is elevated in settings in which myocardial ischemia occurs. B-type natriuretic peptide is released during ischemia provoked by exercise testing2 and after acute myocardial infarction (MI), with some patients exhibiting a late increase, possibly related to adverse remodeling.3-6 When measured at the time of presentation, up to 7 days after onset of acute coronary syndrome (ACS), blood concentrations of BNP and N-amino terminal fragment of the prohormone BNP (NT-proBNP) are strongly associated with the short-term and long-term risk of death and new congestive heart failure (CHF).4,7-17 These data have led to approval for use of BNP and NT-proBNP levels for risk stratification in ACS,18 and to the proposal that serial determinations during follow-up may be useful both for additional prognostic assessment as well as monitoring response to therapy.19 However, few studies have evaluated serial measurements of BNP during extended follow-up of patients after ACS. Therefore, we investigated the prognostic value of BNP and changes in its concentration in patients with ACS prior to hospital discharge (study entry), at 4 months, and at 12 months in the A to Z trial.