Potential utility of B-type natriuretic peptides in secondary prevention following percutaneous coronary intervention in remote communities of Western Australia

Abstract

Introduction

A third of all acute coronary events that present in the Australian population occur in patients with established coronary heart disease. This study assessed the prognostic value of combined B-type natriuretic peptides (BNP) measurement and quantitative myocardial perfusion scan (MPS) data for cardiac events (CE).

Material and methods

This retrospective cohort study involved 133 patients from rural Western Australia. The cut-off for normality was 6.0 for qualitative summed difference scores (SDS) of MPS and 400 pg/mL for BNP.

Results

Patients with no CE had a mean SDS and BNP (1.52 with a 95% CI of 0.34 to 2.69), (175.9 with a 95% CI of 112.7-239.1) that was lower than patients with CE (6.54 with 95% CI 4.18-9.89) (P = 0.0003), (669.1 with 95% CI 543.9-794.3) (P < 0.0001). The sensitivity and specificity of combined testing for predicting CE respectively were 79.6% and 86.3% for SDS, 84.6% and 94.1% for BNP, and 100% and 92.7% for SDS and BNP combined.

Discussion and conclusion

Elevated BNP is marginally superior to MPS in predicting CEs in patients who have previously undergone percutaneous coronary intervention (PCI); however, MPS can identify the region of myocardium most at risk. Routine BNP monitoring in this subgroup may serve as secondary prevention by identifying subclinical disease.

Clinical significance

• Rural communities are disproportionately affected by preventable coronary heart disease-related deaths and access to cardiac imaging techniques can be infrequent or unavailable.

• Secondary prevention strategies can reduce hospital readmissions and contribute to improving the management of chronic conditions.

• This study demonstrated that elevated B-type natriuretic peptides levels were marginally superior to myocardial perfusion scans in predicting cardiac events in patients with prior percutaneous coronary intervention.

• Monitoring BNP levels in rural patients with prior percutaneous coronary interventions is a relatively non-invasive and inexpensive, and may lead to improved risk estimation, identify the subclinical disease and provoke further investigation as clinically appropriate.

Keywords:

• cardiovascular disease
• myocardial perfusion scan
• cardiac event
• rural
• ischaemic heart disease

Disclosure statement

No potential conflict of interest was reported by the authors.

Data availability statement

Raw data were generated at TeleMed Health Services. Derived data supporting the findings of this study are available from the corresponding author PT on request.

Additional information

Funding

The authors would like to thank Rural Health West, Western Australia for their support under the Medical Outreach Health Fund.