B type natriuretic peptide (BNP) and its pro-peptide N terminal fragment (NTproBNP) are raised in conditions associated with abnormal ventricular structure and function and are independent predictors of survival in diverse clinical settings. Patients without raised baseline plasma BNP demonstrate an early, transient increase in concentrations following percutaneous coronary intervention (PCI),¹ but longer term effects are unknown. Potential benefits of PCI on ventricular remodelling are likely to be greatest in patients with raised baseline plasma BNP concentrations, reflecting increased wall stress or ongoing ischaemia. We hypothesised that in patients with stable coronary disease and an elevated baseline NTproBNP, successful PCI would result in a significant reduction in the plasma concentration.

METHODS

The study population was recruited from a larger prospective study of risk factors for coronary in-stent restenosis.² To define an elevated baseline value, NTproBNP was measured in a group of 30 healthy volunteers of similar age and sex distribution (mean age 50 years, 83% male) to the patient group who had no history or clinical signs of cardiovascular disease, and underwent comprehensive non-invasive testing to exclude cardiac pathology. The 90th centile was selected as the cut-off value to define raised NTproBNP, corresponding to an NT proBNP concentration of >75 fmol/ml. Local ethics committee approval was obtained and all subjects gave written informed consent.

Twenty eight patients with …