Prognostic Value of B-Type Natriuretic Peptides in Patients With Stable Coronary Artery Disease: The PEACE Trial

doi:10.1016/j.jacc.2007.03.038

Journal of the American College of Cardiology

Volume 50, Issue 3, 17 July 2007, Pages 205-214

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Objectives

The purpose of this study was to assess the association between B-type natriuretic peptide (BNP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) and the incidence of specific cardiovascular events in low-risk patients with stable coronary disease, the incremental prognostic information obtained from these two biomarkers compared with traditional risk factors, and their ability to identify patients who may benefit from angiotensin-converting enzyme (ACE) inhibition.

Background

The prognostic value of BNPs in low-risk patients with stable coronary artery disease remains unclear.

Methods

Baseline plasma BNP and NT-proBNP concentrations were measured in 3,761 patients with stable coronary artery disease and preserved left ventricular function participating in the PEACE (Prevention of Events With Angiotensin-Converting Enzyme Inhibition) study, a placebo-controlled trial of trandolapril. Multivariable Cox regression was used to assess the association between natriuretic peptide concentrations and the incidence of cardiovascular mortality, fatal or nonfatal myocardial infarction, heart failure, and stroke.

Results

The BNP and NT-proBNP levels were strongly related to the incidence of cardiovascular mortality, heart failure, and stroke but not to myocardial infarction. In multivariable models, BNP remained associated with increased risk of heart failure, whereas NT-proBNP remained associated with increased risk of cardiovascular mortality, heart failure, and stroke. By C-statistic calculations, BNP and NT-proBNP significantly improved the predictive accuracy of the best available model for incident heart failure, and NT-proBNP also improved the model for cardiovascular death. The magnitude of effect of ACE inhibition on the likelihood of experiencing cardiovascular end points was similar, regardless of either BNP or NT-proBNP baseline concentrations.

Conclusions

In low-risk patients with stable coronary artery disease and preserved ventricular function, BNPs provide strong and incremental prognostic information to traditional risk factors.

Abbreviations and Acronyms

ACE

angiotensin-converting enzyme

BNP

B-type natriuretic peptide

EDTA

ethylenediaminetetraacetic acid

NT-proBNP

N-terminal pro-B-type natriuretic peptide

Cited by (0)

Supported by a contract from the National Heart, Lung, and Blood Institute (N01HC65149) and by Knoll Pharmaceuticals and Abbott Laboratories, which also provided the study medication and kits and financial support for BNP analysis, and by Roche Diagnostics, which provided kits and financial support for N-terminal pro-B-type natriuretic peptide analysis.

Brigham and Women’s Hospital has been awarded patents regarding the use of inhibition of the renin-angiotensin system in selected survivors of myocardial infarction; Drs. Pfeffer and Braunwald are among the coinventors; the licensing agreement with Abbott Laboratories and Novartis is not linked to sales. Mariell L. Jessup, MD, FACC, served as Guest Editor for this article.

See accompanying online Cardiosource Slide Set.

¹: Drs. Jablonski and Rice are supported in part by NIH/NHLBI grant N01 HC065149 and a supplement from Knoll Pharmaceuticals and Abbott Laboratories.

²: Dr. Omland has received speaker’s honoraria from Abbott Laboratories, Bayer Diagnostics, and Roche Diagnostics.

³: Dr. Sabatine has received a research grant from Roche Diagnostics.

⁴: Drs. Jablonski and Rice have received research grants from Knoll Pharmaceuticals and Abbott Laboratories.

⁵: Dr. Hsia has received speaker’s honoraria from Abbott Laboratories.

⁶: Dr. Hall is an inventor of 2 patents, owned by Medinnova, Norway, concerning measurement of N-terminal natriuretic peptides.