Abstract 4370697: NT-proBNP is a Powerful Predictor of Adverse Outcomes in Patients with Atherosclerotic Renal Artery Stenosis: A report from the CORAL trial

Abstract

Introduction: N-terminal proBNP (NT-proBNP) is associated with morbidity and mortality in Heart Failure (HF), however it’s prognostic value in Atherosclerotic Renal Artery Stenosis (ARAS) is not established. Hypothesis: NT-proBNP will be associated with adverse outcomes and mortality in people with ARAS. Methods: The CORAL trial enrolled participants with ARAS and hypertension. NT-proBNP was measured using the Abbott Alinity i assay. We compared normal (NTproBNP<125pg/mL) vs. elevated (NTproBNP≥125pg/mL) groups. NT-proBNP levels were also analyzed by quartiles. Outcomes were reported through 3 year follow up. The primary endpoint is a composite of death, myocardial infarction (MI), stroke, HF hospitalization, progression to end-stage renal disease or acute kidney injury event. Individual endpoints were also assessed. Results: 702 participants had plasma available for measurement of NT-proBNP. Median value for NT-proBNP was 331.1pg/mL with IQR of 163.4-718.2pg/mL. Using the established cutpoint of 125pg/mL for outpatients, 81% of patients had elevated NT-proBNP. Elevated NT-proBNP was associated with higher hazard of the composite endpoint(HR 2.1, 95% CI=1.45-3.03), death(HR 5.46, 95% CI=1.72-17.38) and HF hospitalization(HR 3.78, 95% CI=1.37-10.39). In quartile analysis, NTproBNP quartiles were as follows: Q1=11.2–161; Q2=162–330; Q3=331–723; Q4=724–21,211 pg/mL. Those in quartile 4 experienced the composite endpoint at a rate of 53.7% compared to 20% in quartile 1 ( p <0.001). Those in quartile 4 had significantly higher hazard of the composite endpoint (HR 3.37, 95% CI=2.38-4.77), death (HR 11.45, 95% CI=4.08-32.14), HF hospitalization (HR 10.86, 95%CI=3.85-30.64) and progression to ESRD (HR 15.02, 95% CI=1.95-115.62) as compared to quartile 1. When comparing event rates between randomized treatments of medical therapy alone vs. stent plus medical therapy, composite endpoint rates between randomized groups were similar in the normal and elevated NT-proBNP subgroups. Conclusion: NT-proBNP is an effective biomarker for predicting adverse events in people with ARAS, but does not predict treatment response to stent intervention.