N-terminal B-type natriuretic peptide predicts extent of coronary artery disease and ischemia in patients with stable angina pectoris

Am Heart J. 2004 Oct;148(4):612-20. doi: 10.1016/j.ahj.2004.04.021.


Background: B-type natriuretic peptide (BNP) and its N-terminal fragment (NT-proBNP) are elevated in patients with acute coronary syndromes and are closely linked to prognosis. Because there is only a small amount of data available concerning NT-proBNP in patients with stable angina pectoris, we aimed to determine whether NT-proBNP is of additional diagnostic value in these patients.

Methods and results: Ninety-four patients with stable angina pectoris were prospectively included. All patients underwent exercise testing and coronary angiography, and 91 patients received thallium-201 single-photon emission computed tomography myocardial scintigraphy. NT-proBNP was analyzed at rest and after exercise testing. NT-proBNP was elevated in patients with inducible myocardial ischemia shown by single-photon emission computed tomography (396 +/- 80 pg/mL vs 160 +/- 101 pg/mL; P <.01) closely linked to the extent of coronary artery disease (CAD) (no CAD, 148 +/- 29 pg/mL; 1- or 2-vessel disease, 269 +/- 50 pg/mL; 3-vessel disease 624 +/- 186 pg/mL; P <.01). In a multivariate analysis, NT-proBNP was an independent predictor for CAD. The area under the curve of the receiver operating characteristic curve was 0.72 for NT-proBNP to predict CAD. Using an optimized cut off level of 214 pg/mL, CAD can be predicted with high accuracy. The total test efficiency of exercise testing can be improved from 1.46 to 1.52 when combined with NT-proBNP measurement.

Conclusion: NT-proBNP is elevated in patients with stable angina pectoris and has a close correlation to disease severity. Combining the measurement of NT-proBNP with exercise testing, the test accuracy for predicting severe CAD can be improved. Our data show an incremental value of NT-proBNP in the diagnostic process of stable angina pectoris.

Publication types

  • Clinical Trial

MeSH terms

  • Aged
  • Angina Pectoris / blood*
  • Angina Pectoris / classification
  • Biomarkers / blood
  • Coronary Angiography
  • Coronary Disease / blood
  • Coronary Disease / diagnosis*
  • Exercise Test
  • Humans
  • Middle Aged
  • Myocardial Ischemia / blood
  • Myocardial Ischemia / diagnosis*
  • Natriuretic Peptide, Brain / blood*
  • Prospective Studies
  • Severity of Illness Index
  • Thallium Radioisotopes
  • Tomography, Emission-Computed, Single-Photon


  • Biomarkers
  • Thallium Radioisotopes
  • Natriuretic Peptide, Brain