Imperial College London
Alternate

ProfessorPeterCollins

Faculty of Medicine, National Heart & Lung Institute

Professor of Clinical Cardiology
 
 
 
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Contact

 

+44 (0)20 7351 8112peter.collins

 
 
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Location

 

Chelsea WingRoyal Brompton Campus

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Summary

 

Publications

Citation

BibTex format

@article{Kotecha:2019:10.1186/s12916-019-1306-9,
author = {Kotecha, D and Flather, MD and Atar, D and Collins, P and Pepper, J and Jenkins, E and Reid, CM and Eccleston, D},
doi = {10.1186/s12916-019-1306-9},
journal = {BMC Medicine},
title = {B-type natriuretic peptide trumps other prognostic markers in patients assessed for coronary disease},
url = {http://dx.doi.org/10.1186/s12916-019-1306-9},
volume = {17},
year = {2019}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - BackgroundRisk prediction for patients with suspected coronary artery disease is complex due to the common occurrence of prior cardiovascular disease and extensive risk modification in primary care. Numerous markers have the potential to predict prognosis and guide management, but we currently lack robust ‘real-world’ evidence for their use.MethodsProspective, multicentre observational study of consecutive patients referred for elective coronary angiography. Clinicians were blinded to all risk assessments, consisting of conventional factors, radial artery pulse wave analysis, 5-minute heart rate variability, high-sensitivity C-reactive protein and B-type natriuretic peptide (BNP). Blinded, independent adjudication was performed for all-cause mortality and the composite of death, myocardial infarction or stroke, analysed with Cox proportional hazards regression.ResultsFive hundred twenty-two patients were assessed with median age 66 years and 21% prior revascularization. Median baseline left ventricular ejection fraction was 64%, and 62% had ≥ 50% stenosis on angiography. During 5.0 years median follow-up, 30% underwent percutaneous and 16% surgical revascularization. In multivariate analysis, only age and BNP were independently associated with outcomes. The adjusted hazard ratio per log unit increase in BNP was 2.15 for mortality (95% CI 1.45–3.19; p = 0.0001) and 1.27 for composite events (1.04–1.54; p = 0.018). Patients with baseline BNP > 100 pg/mL had substantially higher mortality and composite events (20.9% and 32.2%) than those with BNP ≤ 100 pg/mL (5.6% and 15.5%). BNP improved both classification and discrimination of outcomes (p ≤ 0.003), regardless of left ventricular systolic function. Conversely, high-sensitivity C-reactive protein, pulse wave analysis and heart rate variability were unrelated to prognosis at 5 years afte
AU  - Kotecha,D
AU  - Flather,MD
AU  - Atar,D
AU  - Collins,P
AU  - Pepper,J
AU  - Jenkins,E
AU  - Reid,CM
AU  - Eccleston,D
DO  - 10.1186/s12916-019-1306-9
PY  - 2019///
SN  - 1741-7015
TI  - B-type natriuretic peptide trumps other prognostic markers in patients assessed for coronary disease
T2  - BMC Medicine
UR  - http://dx.doi.org/10.1186/s12916-019-1306-9
UR  - http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000463676500001&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
UR  - http://hdl.handle.net/10044/1/74045
VL  - 17
ER  -
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