J Cardiovasc Interv.  2025 Jan;4(1):56-67. 10.54912/jci.2024.0023.

Combined Serum N-Terminal Pro-Brain Natriuretic Peptide Level and Ejection Fraction for Risk Prediction in Patients With Chronic Total Occlusion Who Underwent Successful Interventions

• Kim KH
• Choi BG
• Rha SW

• KMID: 2564255
• DOI: http://doi.org/10.54912/jci.2024.0023

Abstract

Background
N-terminal pro-brain natriuretic peptide (NT-proBNP) is activated in patients with myocardial infarction. However, the prognostic value of NT-proBNP in patients with chronic total occlusion (CTO) remains unexplored. This study aimed to assess the prognostic value of NT-proBNP levels in CTO patients who underwent successful percutaneous coronary intervention (PCI).
Methods
In total, 351 patients with CTO who underwent successful PCI and were assessed for NT-proBNP and echocardiography were enrolled. The NT-proBNP levels were evaluated based on baseline echocardiographic parameters and clinical outcomes. Patients were categorized into 4 profiles based on their NT-proBNP levels and left ventricular ejection fraction (EF): EF ≥ 50% & NT-proBNP < 450 pg/mL, EF ≥ 50% & NT-proBNP ≥ 450 pg/mL, EF < 50% & NT-proBNP < 450 pg/mL, EF < 50% & NT-proBNP ≥ 450 pg/mL.
Results
The mean age was 63 years;74% were men, and baseline EF was 52%. The baseline NT-proBNP concentration in CTO patients was high, averaging 1,507 pg/mL. During an average follow-up of 7.8 years, there were 27 deaths. NT-proBNP levels significantly differentiated between survivors and non-survivors (1,154 vs. 5,666 pg/mL, P < 0.01).Multiple logistic regression identified age (hazard ratio [HR], 1.15, 95% confidence interval [CI], 1.08–1.23, P < 0.01) and group (Groups 4 vs. 1: HR, 16.5, 95% CI, 1.2–22.5, P = 0.02; Groups 3 vs. 2: HR, 6.1, 95% CI, 1.5–8.6, P = 0.01) as independent significant predictors of mortality.
Conclusions
In CTO patients who underwent successful PCI, the combined measurement of NT-proBNP levels and EF provided valuable additional information for predicting mortality. In patients with preserved EF, the prognostic value of NT-proBNP seems to be less significant compared to those with reduced EF. Further research is necessary to clarify the role of NT-proBNP in predicting outcomes for this subgroup of CTO patients following successful revascularization.

Keyword

NT-proBNP; Coronary artery disease; Heart failure