NT-ProBNP independently predicts long-term mortality in patients admitted for coronary angiography.

Recently, research interests are focussed on biomarkers to predict the outcome in patients with coronary artery disease (CAD). We examined whether the levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP) could predict outcome in patients who underwent elective or acute coronary angiography (CAG). A total of 337 patients with suspected CAD who underwent elective or acute CAG were followed up for a mean period of 6.7 years. Primary end points were all-cause mortality (ACM) and the combined end point of ACM, nonfatal myocardial infarction, and revascularization. In all, 53 (16%) patients died and 88 (26%) patients reached the combined end point. Preprocedural NT-proBNP above 32 pmol/L independently predicted ACM (hazard ratio [HR] 3.11; confidence interval [CI]: 1.60-6.07; P = .001) and the combined end point (HR 2.44 [CI: 1.50-3.97]; P < .001). This study indicates that high NT-proBNP is an independent predictor of ACM on long-term follow-up. N-terminal-proBNP is a reliable predictive marker of mortality in the setting of stable or unstable angina.

High prevalence of risk factors in coronary artery disease in EUROPA gives HOPE for ACE inhibitors after PEACE.

BACKGROUND: Routine use of ACE inhibitors (ACE-I) as secondary preventive therapy for all patients with coronary artery disease (CAD) is challenged by the PEACE trial. Currently it is unclear to what extent ACE-I should be used in CAD populations. PURPOSE: To analyze the prevalence of left ventricular systolic dysfunction, diabetes, myocardial infarction and hypertension in an unselected and consecutive population of patients with documented CAD and evaluate the potential need for ACE-I treatment in a real-life scenario. METHODS: We searched a database containing all invasive cardiac investigations in three hospitals in Copenhagen from July 1, 2000 to June 30, 2003. Patients with no angiographic sign of CAD were excluded. RESULTS: Among 7,345 patients, 4,180 had stable CAD and 3,165 had acute coronary syndrome (ACS). Among the stable CAD patients 78% had at least one of the following indications for treatment with an ACE-I: left ventricular ejection fraction <0.45 (20%), hypertension (39%), diabetes (19%), systolic blood pressure >159 mm Hg (21%), and/or myocardial infarction (42%). Among ACS patients, 90% had an indication for ACE-I treatment. CONCLUSION: Depending on the definitions, at least 78% of the patients with stable CAD and 90% with ACS have an accepted indication for treatment with an ACE-I.

[Yield of a coronary arteriography database. A study of 5.536 registrations at the cardiologic laboratory, Rigshospitalet]. / Udbyttet af en database over koronararteriografier. En opgørelse af 5.536 registreringer på kardiologisk laboratorium, Rigshospitalet.

INTRODUCTION: Coronary arteriography (CAG) is an expensive investigation that provides potentially valuable information, but also carries a risk of severe complications. It is therefore natural to examine the usefulness of an existing database on CAG. METHODS: The analysis covers all registrations of CAG entered into the database at the Heart Centre at Rigshospitalet, Copenhagen, from April 1999 to September 2000. RESULTS: Altogether, 5536 CAGs were registered. The indication was stable coronary artery disease in 52.0% and acute ischaemic heart disease in 25.5%. As an example of the medical information available from the data base, it is notable that left main coronary stenosis or three-vessel disease, conditions in which coronary bypass surgery increases long-term survival, was found in 42.4% of patients with angina pectoris in Canadian Cardiovascular Society (CCS) class 4, but also in 24.4% of patients in CCS class 1. DISCUSSION: Clinical databases, such as the one presented, can ensure that all relevant information is stored, and in this case even results in enhanced effectiveness, because data may be directly transformed into other formats, such as charts. The database furthermore provides clinical information, for instance that the severity of angina pectoris cannot identify the most ill patients in whom a CABG is potentially life-prolonging. In addition, the database provides administrative data that is used in the training of doctors, evaluation of referral patterns, surveillance of complications, and in the daily administration and planning.