Quantifying Heart Failure Using Natriuretic Peptides May Help the HEART Teamin Decision-making

Eleni Michou; Gregor Fahrni; Christian Mueller

Disclosures

Eur Heart J. 2019;40(41):3406-3408. 

In This Article

What Is the Evidence in Detail?

Among 1037 patients with left main CAD randomized to PCI or CABG, BNP concentration was elevated (>100 pg/mL) in ~40% of them. Patients with elevated BNP had higher 3-year rates of the composite of all-cause death, myocardial infarction, or stroke [adjusted hazard ratio (HR) 1.62], mainly driven by higher mortality (adjusted HR 2.49). A significant interaction (Pinteraction = 0.03) was present between elevated vs. normal BNP and treatment with PCI vs. CABG for the adjusted risk of the primary composite endpoint at 3 years (adjusted HR for PCI vs. CABG 1.54 among patients with elevated BNP vs. adjusted HR 0.74 among patients with normal BNP). This interaction was stronger when BNP was modelled as a log-linear continuous variable (Pinteraction = 0.002).[3] Among 6597 patients with three-vessel CAD, higher NT-proBNP concentrations were strongly associated with increased risk of all-cause death and the composite of all-cause death, myocardial infarction, or stroke, over a mean follow-up of 7.0 years. Again, a significant interaction between NT-proBNP concentrations and treatment strategies for the composite of all-cause death, myocardial infarction, or stroke was observed (P = 0.004). Revascularization (PCI or CABG) was associated with lower risk of all-cause death, myocardial infarction, or stroke compared with medical therapy, with the exception of patients in the lowest quartile (normal NT-proBNP concentrations) in whom no such association was observed. Among patients in the highest quartile (moderately elevated NT-proBNP concentrations), PCI was associated with an increased risk compared with CABG (HR 1.43).[4]

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