Risk stratification for patients undergoing nonurgent percutaneous coronary intervention using N-terminal pro–B-type natriuretic peptide: A Clopidogrel for the Reduction of Events During Observation (CREDO) substudy - 09/08/11
, Steven R. Steinhubl, MD c, Frederick Van Lente, PhD b, Danielle Brennan, MS a, Ellen McErlean, RN a, Anjli Maroo, MD a, Gary S. Francis, MD a, Eric J. Topol, MD dRésumé |
Background |
The utility of N-terminal pro-BNP (NT-proBNP) measurement as a prognostic marker during nonurgent percutaneous coronary intervention (PCI) has been suggested in several studies. The comparative prognostic values between NT-proBNP levels and left ventricular ejection fraction (LVEF) in the nonurgent PCI setting are unclear.
Methods |
CREDO was a double blind, placebo-controlled, randomized trial comparing 2 clopidogrel regimens before and after nonurgent PCI. Baseline NT-proBNP levels and LVEF were measured in 1468 subjects using the Roche Elecsys proBNP assay (Roche Diagnostics, Indianapolis, IN), and the 1-year combined end point of death/myocardial infarction (MI)/stroke was analyzed according to NT-proBNP quartiles in impaired and preserved LVEF.
Results |
In this patient cohort (mean age 61.6 ± 10 years, 22% with LVEF <50%), the median NT-proBNP level was 131 pg/mL. Increasing quartiles of NT-proBNP were associated with a higher rate of death, MI, and the combined end point (but not stroke) at 1 year, including those with LVEF ≥50% (P < .001 for trend). This prognostic power for death and MI remained robust even when adjusted for other clinical or biochemical markers including cardiac troponin, creatinine clearance, and high-sensitive C-reactive protein (hazard ratio 1.249, P = .006). Despite its robust prognostic value, baseline NT-proBNP levels did not identify patients with enhanced benefit from pre-procedural and prolonged clopidogrel therapy.
Conclusions |
In patients undergoing a nonurgent PCI, NT-proBNP levels may provide important prognostic value for death and MI, even in patients with preserved cardiac function, However, NT-proBNP levels were unable to identify patients with enhanced benefit from pre-procedural and prolonged clopidogrel therapy.
Le texte complet de cet article est disponible en PDF.Plan
| The CREDO study was sponsored by Sanofi-Synthélabo; NT-proBNP assay reagents provided by Roche Diagnostics Inc for this substudy. |
Vol 153 - N° 1
P. 36-41 - janvier 2007 Retour au numéro
Article précédent
- Global Registry of Acute Coronary Events (GRACE) hospital discharge risk score accurately predicts long-term mortality post acute coronary syndrome
- Eng Wei Tang, Cheuk-Kit Wong, Peter Herbison
- Platelet reactivity in patients with subacute stent thrombosis compared with non–stent-related acute myocardial infarction
- Eli I. Lev, Carlos L. Alviar, Mehmet E. Arikan, Bijal P. Dave, Juan F. Granada, Timothy DeLao, Armando Tellez, Kelly Maresh, Neal S. Kleiman
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?