Accuracy of N-terminal probrain natriuretic peptide to predict mortality or detect acute ischemia in patients with coronary artery disease

Objective: The aim of the study was to assess the accuracy of N-terminal probrain natriuretic peptide (NT-proBNP) to predict mortality or detect acute ischemia in patients with coronary artery disease (CAD). Methods: This study included 1,552 patients with stable (n = 1,059) or unstable (n = 493) CAD undergoing percutaneous coronary intervention. NT-proBNP was measured before percutaneous coronary intervention. The primary endpoint of the study was mortality. Patients were followed for 3.6 years. Results: There were 171 deaths (11%) during follow-up. In the entire group of patients, NT-proBNP had the best accuracy to predict mortality (area under receiver operating characteristic curve 0.76, 95% CI 0.72-0.80). In patients without congestive heart failure (n = 760) there were 46 deaths (6%). The area under receiver operating characteristic curve of NT-proBNP was reduced to 0.70 (95% CI 0.63-0.79) which was not better than the area under curve of age (p = 0.981) or C-reactive protein (p = 0.082) regarding mortality. NT-proBNP showed limited power to detect patients with acute ischemia (area under curve 0.63, 95% CI 0.60-0.66) among consecutive patients with stable and unstable CAD. Conclusions: NT-proBNP has a moderate accuracy to predict mortality and does not assist in the diagnosis of acute myocardial ischemia in patients with CAD.