Is N-terminal pro B-type natriuretic peptide (NT-proBNP) a useful screening test for angiographic findings in patients with stable coronary disease?

Abstract

Background: Whether N-terminal pro B-type natriuretic peptide (NT-proBNP) is a useful screening tool for angiographic coronary artery disease in patients with angina is not known. Therefore, the purpose of this study was to assess the diagnostic test performance of NT-proBNP in detecting coronary atherosclerotic lesions, as assessed by coronary angiography.

Methods: We examined 1034 patients referred for diagnostic angiography because of symptoms or signs of coronary artery disease. The diagnostic value of NT-proBNP in predicting clinically significant coronary disease was assessed.

Results: In a multiple logistic regression model, NT-proBNP above the upper normal limit (125 pg/mL) predicted clinically significant coronary disease at angiography independently of traditional cardiovascular risk factors and invasive measurements of left ventricular function (odds ratio 2.1, 95% CI 1.3-3.2, P = .001). The ability of NT-proBNP in detecting clinically significant coronary disease at angiography was modest, however, with sensitivity of 0.61, specificity 0.60, accuracy 61 (95% CI 58-64), positive likelihood ratio 1.5 (95% CI 1.3-1.8), negative likelihood ratio 0.7 (95% CI 0.6-0.8), and area under the ROC curve 0.61 (95% CI 0.58-0.64).

Conclusions: NT-proBNP is associated with clinically significant coronary disease at angiography, independently of left ventricular dysfunction. However, NT-proBNP is not a useful screening test for diagnosing significant angiographic lesions in patients with stable coronary disease.