nÃo hà / As doenÃas cardiovasculares, incluindo a cardiopatia isquÃmica aterosclerÃtica, sÃo a princi-pal causa de morte no Brasil. A aterosclerose à doenÃa inflamatÃria crÃnica que se inicia na infÃncia, progride lentamente e se expressa dÃcadas depois. Ela principia por disfunÃÃo do endotÃlio, tem patogÃnese multifatorial e tem, como principais fatores de risco, o sexo mascu-lino, a idade, o tabagismo, a hipercolesterolemia, a hipertensÃo arterial sistÃmica (HAS), o diabetes mellitus (DM) e o antecedente familiar de doenÃa aterosclerÃtica precoce. A elevaÃÃo de vÃrios marcadores bioquÃmicos sinaliza a participaÃÃo da inflamaÃÃo na aterosclerose. O peptÃdeo natriurÃtico tipo B e o fragmento amino-terminal do pro-peptÃdeo natriurÃtico tipo B (NT-proBNP) tambÃm aumentam na aterosclerose coronÃria. Esse trabalho à um estudo ob-servacional, transversal, de uma sÃrie consecutiva de 153 pacientes internados na Enfermaria de Cardiologia do HUWC-UFC, no perÃodo de 01.08.2007 a 31.03.2008, com hipÃtese diag-nÃstica de cardiopatia isquÃmica â angina estÃvel (AE), angina instÃvel (AI) ou infarto agudo do miocÃrdio (IAM) â submetidos à cineangiocoronariografia, comparando-se o grupo porta-dor de obstruÃÃo aterosclerÃtica coronÃria angiogrÃfica (grupo A) com aquele de artÃrias co-ronÃrias angiograficamente normais (grupo B). Os critÃrios de exclusÃo foram revasculariza-ÃÃo miocÃrdica prÃvia â cirÃrgica ou percutÃnea â insuficiÃncia renal dialÃtica aguda ou crÃni-ca, neoplasia maligna, infecÃÃo, doenÃa inflamatÃria aguda ou crÃnica, doenÃa pulmonar, he-pÃtica ou hematolÃgica e cardiopatia valvar, congÃnita ou cardiomiopatia associada. Ambos os grupos foram analisados, de modo semelhante, quanto ao sexo, à idade, à escolaridade, ao Ãndice de massa corporal (IMC), à circunferÃncia abdominal (CA), ao tabagismo, ao DM, à HAS, à histÃria familiar positiva para aterosclerose precoce, ao uso de estatina, à presenÃa de sÃndrome metabÃlica (SM) e à apresentaÃÃo clÃnica como AE, AI ou IAM. Eles tambÃm fo-ram analisados em relaÃÃo ao eletrocardiograma, à radiografia do tÃrax e ao ecocardiograma, quanto à presenÃa ou nÃo de disfunÃÃo sistÃlica; ao colesterol nÃo-HDL, à HDL-colesterol, à relaÃÃo do colesterol total / HDL-colesterol < 5 e do LDL-colesterol / HDL-colesterol < 3,5; à creatinina e o ao fibrinogÃnio, ao nÃmero de leucÃcitos totais e ao de monÃcitos, à proteÃna C reativa ultra-sensÃvel e ao NT-proBNP. A comparaÃÃo dos dois grupos revelou, com signifi-cÃncia estatÃstica, à anÃlise univariada, que os pacientes do grupo A tinham prevalÃncia maior de DM e de disfunÃÃo sistÃlica, NT-proBNP &#8805; 250 pg/ml, fibrinogÃnio acima de 500 mg/dl; mais frequentemente usavam estatina e tinham monÃcitos 501 ou mais por mm3 do que aque-les do grupo B. Curiosamente, o IMC &#8805; 30 e a CA aumentada foram mais prevalentes no gru-po com artÃrias coronÃrias normais. No entanto, pela regressÃo logÃstica multivariada, os fato-res independentes para oclusÃo aterosclerÃtica coronariana angiogrÃfica foram o NT-proBNP &#8805; 250 pg/ml, o DM e o aumento do fibrinogÃnio e dos monÃcitos, mesmo consideradas a creatinina e a disfunÃÃo sistÃlica. Na amostra estudada, o modelo com ajuste de prevalÃncia desses fatores teve sensibilidade de 80,4%, especificidade de 76,9 e 79,7% de acurÃcia para o diagnÃstico de oclusÃo coronariana aterosclerÃtica angiogrÃfica. / Cardiovascular diseases, including ischemic heart disease, are the main causes of death in Brazil. Atherosclerosis is a chronic inflammatory disease that starts in the childhood, progresses slowly and shows up many decades later. It begins as an endothelial dysfunction and has as its main risk factors the male sex, age, smoking, hypercholesterolemia, arterial hypertension, diabetes mellitus and a background of early family atherosclerotic disease. The rise of many biochemical markers in the plasma signals the presence of inflammation in the atherosclerosis. The brain natriuretic peptide and the amino-terminal pro-B-type natriuretic peptide (NT-proBNP) also increase in coronary atherosclerosis. This is a cross-sectional and observational study of 153 in-patients at the Cardiology Ward of HUWC-UFC from 08.01.2007 to 03.31.2008 with the diagnostic hypothesis of Ischemic Heart Disease, i.e., stable angina, unstable angina or acute myocardial infarction. All of them underwent heart catheterization and coronary angiography. They were classified respectively as group A or B in accordance with the presence or not of angiographic atherosclerotic coronary occlusion. Patients were not included in the analysis if they had been submitted to surgical or percutaneous revascularization; had an acute or chronic dialytic kidney disease; cancer or infection; a lung, hepatic or hematopoietic disease; an acute or chronic inflammatory illness or associated myocardial, valvular or congenital heart disease. The two groups were analyzed in a similar way with regard to gender, age, level of education, body mass index, abdominal circumference, smoking, diabetes mellitus, arterial hypertension, an early atherosclerosis family history, the use of statin, presence of metabolic syndrome and clinical presentation of stable angina, unstable angina or acute myocardial infarction. The HDL-cholesterol, non HDL-cholesterol, a total cholesterol/HDL-cholesterol ratio < 5, a LDL-cholesterol/HDL-cholesterol ratio < 3.5, the creatinine and fibrinogen plasma concentration, the total leukocyte and monocyte count, the high-sensitivity C reactive protein, the NT-proBNP, the electrocardiogram, the chest radiography and the echocardiogram, with regard to the presence or not of systolic dysfunction, were also analyzed. The univariety analysis comparing both groups revealed that group Aâ patients more frequently were diabetics and had systolic dysfunction, NT-proBNP &#8805; 250 pg/ml, fibrinogen higher than 500 mg/dl, more frequent use of statin and 501 or more monocytes/mm3 than patients group B. Curiously, the body mass index &#8805; 30 and abnormal abdominal circumference were more frequently found among patients with angiographic normal coronary arteries. Nevertheless, by multivariety regression logistic analysis the independent factors for angiographic atherosclerotic coronary occlusion were the NT-proBNP &#8805; 250 pg/ml, diabetes mellitus, an increase of monocyte number and of fibrinogen plasma concentration, in spite of creatinine level and presence of systolic dysfunction. The model takes into account these factors has 80.4% sensitivity, 76.9% specificity and 79.7% of accuracy for the diagnostic of angiographic atherosclerotic coronary occlusion.