Assessment of the dynamics of cardiological markers (LV systolic function, NT-proBNP) and its relationship with actual adherence to drug therapy in patients with stable coronary artery disease after planned myocardial revascularization

Abstract

Objective: to evaluate the dynamics of left ventricular ejection fraction (LVEF) and N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with stable coronary artery disease (CAD) before and after planned myocardial revascularization and to analyze their association with actual adherence to drug therapy. Material and methods: a cross-sectional observational study was conducted based on data from a specialized registry. The study included 300 patients with stable CAD, functional class III (CCS), aged 50–80 years, hospitalized for elective myocardial revascularization: 107 (35.7%) for coronary artery bypass grafting (CABG) and 193 (64.3%) for percutaneous coronary intervention (PCI). Adherence was assessed using the National Society for Evidence-Based Pharmacotherapy (NSEBP) scale (potential, overall actual, and actual adherence to specific drugs and drug classes). The dynamics of markers were evaluated 6 days after surgery, taking into account thresholds for significant changes: ΔLVEF >5–10%, ΔNT-proBNP >20%. The lowest actual adherence was recorded for statins (62% of patients took >80% of prescribed doses), and the highest for antiplatelet agents (86%). Results: total actual adherence moderately correlated with a decrease in NT-proBNP (ρ = 0.38; p = 0.001) but weakly with LVEF dynamics (ρ = 0.29; p = 0.018). Potential adherence showed no significant correlation (ρ = 0.09; p = 0.32). The greatest relative reduction in NT-proBNP was observed in the group with the highest baseline level (Group C – 405 pg/mL, reduction 37%), which is explained by regression to the mean. In the group with high actual adherence (Group A), the reduction in NT-proBNP was 26%. Low adherence to statins was associated with a smaller reduction in NT-proBNP (16% vs. 28%, p = 0.003). LVEF dynamics at 6 days did not differ between adherence groups (p = 0.21). Conclusion: actual adherence is associated with NT-proBNP dynamics but not with early LVEF dynamics. The lowest adherence was observed for statins, which requires additional attention. Accounting for analytical variability (thresholds for significant changes) is necessary for correct interpretation of the results.