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Prognostic Value of B-Type Natriuretic Peptides in Patients with Stable Coronary Artery Disease

Prognostic Value of B-Type Natriuretic Peptides in Patients with Stable Coronary Artery Disease. The PEACE trial. Omland T, et al. JACC 2007;50:205-14. Objectives. In low-risk patients with stable coronary disease and preserved LV function, to assess:

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Prognostic Value of B-Type Natriuretic Peptides in Patients with Stable Coronary Artery Disease

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  1. Prognostic Value of B-Type Natriuretic Peptides in Patients with Stable Coronary Artery Disease The PEACE trial Omland T, et al. JACC 2007;50:205-14

  2. Objectives • In low-risk patients with stable coronary disease and preserved LV function, to assess: • the association between BNP and NT-proBNP and the incidence of specific cardiovascular events • the incremental prognostic information obtained from these two biomarkers compared with traditional risk factors • the ability of BNP and NT-proBNP to identify patients who may benefit from ACE inhibition Omland T, et al. JACC 2007;50:205-14

  3. The Prevention of Events with Angiotensin Converting Enzyme Inhibition (PEACE) Trial • A double-blind, placebo-controlled, randomized trial • Sponsored by the National Heart, Lung, and Blood Institute • Study medication and additional support provided by Abbott Laboratories / Knoll • Natriuretic peptide analyses supported by Abbott Laboratories and Roche Diagnostics • N = 8290 • Inclusion Nov 1996 - June 2000 • Followed until Dec 31 2003 • Median follow-up time = 4.8 years Omland T, et al. JACC 2007;50:205-14

  4. Inclusion Criteria • Age  50 years • Coronary artery disease • MI, or • CABG or PCI, or • Coronary angiogram with obstruction of 50% luminal diameter in at least one native vessel • LVEF > 40% • Tolerated 2 week run-in of 2 mg/day trandolapril Omland T, et al. JACC 2007;50:205-14

  5. Major Exclusions • Current use, indication for or contraindication to ACE-I or ARB • CV event in previous 3 months • Planned elective coronary revasc • Creatinine > 2.0 mg/dl • Potassium > 5.5 mEq/L • Limited 5-year survival Omland T, et al. JACC 2007;50:205-14

  6. Biomarker substudy • N=3762 • No major difference between patients included vs those not included • Blood samples centrifuged within 45 min • EDTA plasma stored at -70°C or lower until 2005 • Baseline plasma samples analyzed for BNP and NT-proBNP on the same day • BNP: 2-step microparticle enzyme immunoassay on an Abbott Ax Sym analyzer • NT-proBNP: electrochemiluminescence immunoassay on a Modular platform (Roche) Omland T, et al. JACC 2007;50:205-14

  7. ResultsPatient characteristics Omland T, et al. JACC 2007;50:205-14

  8. ResultsCorrelation with other risk factors Omland T, et al. JACC 2007;50:205-14

  9. ResultsRisk of CV end-points • Adjusted for randomization status • Hazard Ratio and 95%CI per 1 SD pg/ml in log BNP and log NT-proBNP Omland T, et al. JACC 2007;50:205-14

  10. ResultsAdjusted risk estimates • Adjusted for randomization status, age, sex, BMI, LVEF < 50%, eGFR, current smoking, history of hypertension or measured hypertension, history of MI, diabetes, stroke, PCI, CABG, total chol, CRP, use of a beta blocker, lipid-lowering drug, aspirin or antiplatelet medication, and of a diuretic. • Hazard Ratio and 95%CI per 1 SD pg/ml in log BNP and log NT-proBNP Omland T, et al. JACC 2007; 50:205-14

  11. ResultsPrognostic accuracy Omland T, et al. JACC 2007;50:205-14

  12. ResultsIncremental prognostic value * : p<0.05 vs covariates alone Omland T, et al. JACC 2007;50:205-14

  13. Conclusions • In low-risk patients with stable coronary disease and preserved LV function: • Baseline NT-proBNP concentrations are independently related to the incidence of: • CV death • CHF • Stroke • Baseline BNP concentrations are independently related to the incidence of: • CHF • Neither peptide was predictive of MI Omland T, et al. JACC 2007;50:205-14

  14. Conclusions • Baseline NT-proBNP concentrations provide incremental prognostic information to traditional risk factors for: • CV death • CHF • Baseline BNP concentrations provide incremental prognostic information to traditional risk factors for: • CHF Omland T, et al. JACC 2007;50:205-14

  15. Conclusions • Natriuretic peptide determination did not identify a subset of patients who experienced a greater degree of benefit from ACE-inhibition Omland T, et al. JACC 2007;50:205-14

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