Does Serum N-Terminal pro-Brain Natriuretic Peptide Level Predict the Severity of Angiographic Lesions in Patients with Acute Coronary Syndrome?

BACKGROUND: Serum N-terminal pro-brain natriuretic peptide (NT-proBNP), a polypeptide secreted by ventricular myocytes in response to stretch, was suggested as a predictor of adverse prognosis of the acute coronary syndrome (ACS). We examined the association between NT-proBNP level and angiographic findings in ACS patients to determine whether it could be used as a predictor of the severity of angiographic lesions.

METHODS: This cross-sectional study was performed on 126 patients with chest pain or other ischemic heart symptoms suggestive of ACS. Venous blood samples were drawn to measure serum levels of NT-proBNP. Afterward, coronary angiography was performed and the patients were categorized into four groups according to the number of coronary vessels with significant stenosis. The severity of angiographic lesions was assessed with the Gensini scoring system.

RESULTS: According to angiographic diagnosis, 11 (8.7%) patients had normal coronary arteries (no coronary artery disease [CAD]) and 115 (91.3%) had CAD, of whom 108 (85.7%) had obstructive CAD and 7 (5.6%) had minimal CAD. The serum NT-proBNP concentration was higher in the CAD group than in the non-CAD group (p value <0.01). A progressive significant increase in the NT-proBNP concentration according to the Gensini score and the number of involved vessels was reported after adjustment for sex and age. Furthermore, the Receiver Operating Characteristic Curve (ROC) analysis indicated that an NT-proBNP cut-point of 400 pg/ml could predict obstructive CAD with a sensitivity of 65% and a specificity of 78%.

CONCLUSION: Higher levels of NT-proBNP among our ACS patients were associated with the severity of angiographic lesions in terms of both the Gensini score and the number of involved vessels. This finding underscores the potential role of NT-proBNP in predicting the severity of CAD before performing angiography.