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Clinical Chemistry 55: 68-77, 2009. First published November 6, 2008; 10.1373/clinchem.2008.108753
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(Clinical Chemistry. 2009;55:68-77.)
© 2009 American Association for Clinical Chemistry, Inc.

Proteomics and Protein Markers

Amino-Terminal Pro–B-Type Natriuretic Peptide as Predictor of Mortality in Patients with Symptomatic Peripheral Arterial Disease: 5-Year Follow-Up Data from the Linz Peripheral Arterial Disease Study

Thomas Mueller1,a, Benjamin Dieplinger1, Werner Poelz2, Georg Endler3, Oswald F. Wagner3 and Meinhard Haltmayer1,4

1 Department of Laboratory Medicine, Konventhospital Barmherzige Brueder Linz, Linz, Austria; 2 Institute for Applied System Sciences and Statistics, University of Linz, Linz, Austria; 3 Department of Medical and Clinical Laboratory Diagnostics, Medical University of Vienna, Vienna, Austria; 4 Paracelsus Private Medical University, Salzburg, Austria.

aAddress correspondence to this author at: Department of Laboratory Medicine, Koventhospital Barmherzige Brueder, Seilerstaette 2-4, A-4020 Linz, Austria. Fax +43-732-7677-3799; e-mail thomas.mueller{at}bs-lab.at

Background: Amino-terminal pro–B-type natriuretic peptide (NT-proBNP) has emerged as predictor of mortality endpoints in cardiac disease. In contrast, the prognostic value of NT-proBNP in patients with peripheral arterial disease (PAD) is unclear. Therefore, we aimed to evaluate the capability of NT-proBNP as a marker for long-term prognosis in atherosclerotic PAD.

Methods: We obtained NT-proBNP serum concentrations in 487 consecutive patients with symptomatic PAD admitted to a tertiary-care hospital. The endpoint was defined as all-cause mortality, and the study participants were followed for 5 years.

Results: Of the 487 patients enrolled, 114 died and 373 survived during follow-up. The median NT-proBNP concentration was higher among decedents than survivors (692 vs 143 ng/L; P < 0.001). Using the median NT-proBNP concentration of the entire cohort (213 ng/L) as threshold level, Kaplan–Meier curve analysis demonstrated that the survival probability was lower in patients with NT-proBNP above the median (log-rank test, P < 0.001). In the fully adjusted Cox proportional-hazards regression analysis, NT-proBNP >213 ng/L had a risk ratio of 2.27 (95% CI 1.27–4.03; P = 0.005) independent of age, sex, glomerular filtration rate, clinical stage of PAD, cardiovascular comorbidity, and other potential confounders. Further analyses showed that NT-proBNP added significantly to the value of established and emerging outcome predictors of PAD.

Conclusions: In this study, a NT-proBNP serum concentration >213 ng/L was a robust and independent predictor of 5-year all-cause mortality in patients with symptomatic PAD. Thus, NT-proBNP measurements can be considered a valuable tool for risk stratification in these patients.






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