NT-proBNP was independently associated with obstructive CAD and correlated with coronary disease burden, but its modest discriminatory performance precludes its use as a stand-alone diagnostic test for high-risk coronary anatomy.
NTproBNP levels were significantly higher in patients with obstructive coronary artery disease compared to those without obstructive CAD.
NTproBNP levels increased with the number of vessels involved and degree of coronary stenosis.
After multivariable adjustment, NT-proBNP remained independently associated with obstructive CAD.
Prognostically significant CAD was associated with higher NT-proBNP levels compared to obstructive CAD without prognostic significance.
The discriminatory performance of NT-proBNP for identifying prognostically significant CAD was modest.
This research suggests that a blood marker called NT-proBNP — typically used to diagnose heart failure — is also elevated in patients who have significant blockages in their coronary arteries, even when those patients do not have heart failure. In a study of 676 patients who underwent elective coronary angiography for suspected chronic coronary syndrome (stable heart disease), NT-proBNP levels were higher in those found to have obstructive coronary artery disease, and the levels increased further as the disease became more extensive or severe. Importantly, this association held up even after accounting for other factors that could influence the results, including a highly sensitive troponin test. However, the study also found that while NT-proBNP is statistically associated with more serious coronary disease (such as blockages in the left main artery or the proximal part of the main heart artery), it does not distinguish well enough between high-risk and lower-risk disease on its own. The accuracy measure (AUC of 0.60) indicates only modest discriminatory ability — better than chance, but not good enough to reliably identify which patients have the most dangerous coronary anatomy. This research suggests that NT-proBNP may have a supporting role in evaluating coronary artery disease burden in stable patients — potentially adding information when combined with other tests — but should not be used alone to decide whether a patient has high-risk coronary anatomy. The findings open the door to future research exploring whether NT-proBNP could be integrated into multi-marker or multi-test approaches for risk stratification in stable coronary artery disease.
Schivalocchi M, Mazza R, Gaspardone C, Rigatelli A, Morosato M, Costa P, et al.. (2026). NT-proBNP as a marker of coronary artery disease burden in chronic coronary syndromes.. International journal of cardiology. https://doi.org/10.1016/j.ijcard.2026.134752