A systematic review of BNP as a predictor of prognosis in persons with coronary artery disease

OBJECTIVE: This systematic review was conducted to examine whether B-type natriuretic peptide (BNP) can predict mortality and other cardiac endpoints in persons diagnosed with coronary artery disease (CAD). DESIGN AND METHODS: Databases were searched from 1989 to February 2005 for primary studies that measured BNP for the purpose of diagnosis, prognosis, and monitoring treatment. RESULTS: In 18 studies, concentrations of BNP were found to have consistent positive associations with poorer prognoses for persons with CAD. The overall range of effect (95% confidence interval) was 2.31 to 5.02, measured via a random effects meta-analysis on studies reporting an odds ratio. Prognostic ability was similar for mortality and non-fatal outcomes. Ranges of estimated measures of effect (i.e., odds ratio, relative risk, hazard ratio) were concentrated between 1.33 to 2.94 for mortality and 1.01 to 3.03 for non-fatal outcomes. CONCLUSIONS: Further research is needed to assess whether prognostic ability differs by comorbidity or concomitant treatment. As well, the importance and selection of cut points remains unresolved. Until greater clarity is given to these matters, it would be prudent for clinicians to employ caution when using concentrations of BNP to predict the prognosis of persons with CAD.