High plasma N-terminal pro-brain natriuretic peptide level found in diabetic patients after myocardial infarction is associated with an increased risk of in-hospital mortality and cardiogenic shock
| Autor: | Hamid Makki, Marianne Zeller, Philippe Gambert, Isabelle L’Huillier, Gilles Rioufol, Jean-Claude Beer, Bruno Vergès, Jean Desgres, Gilles Dentan, Luc Rochette, Yves Laurent, Yves Cottin, Luc Janin-Manificat |
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| Rok vydání: | 2005 |
| Předmět: |
Male
medicine.medical_specialty Myocardial Infarction Shock Cardiogenic Sex Factors Recurrence Diabetes mellitus Internal medicine Natriuretic Peptide Brain Blood plasma medicine Humans Hospital Mortality Myocardial infarction Risk factor Aged Ejection fraction biology business.industry Cardiogenic shock Age Factors Stroke Volume Middle Aged Brain natriuretic peptide medicine.disease Troponin Peptide Fragments Surgery Hospitalization Logistic Models Cardiology biology.protein Female Cardiology and Cardiovascular Medicine business Biomarkers Diabetic Angiopathies |
| Zdroj: | European Heart Journal. 26:1734-1741 |
| ISSN: | 1522-9645 0195-668X |
| DOI: | 10.1093/eurheartj/ehi260 |
| Popis: | No studies have yet been conducted concerning plasma N-terminal pro-brain natriuretic peptide (Nt-pro-BNP) levels after Myocardial Infarction (MI) and their relationship with short-term outcomes in diabetic patients.Five hundred and sixty patients hospitalized for MI from the RICO survey, including 199 diabetic and 361 non-diabetic subjects, were included in the study. Plasma Nt-pro-BNP levels were measured on admission. Median Nt-pro-BNP levels were significantly higher in diabetic patients compared with non-diabetic patients [245 (81-77) vs. 130 (49-199) pmol/L, P0.0001]. This difference remained highly significant after adjustment for age, female gender, creatinine clearance, left ventricular ejection fraction (LVEF), plasma peak troponin, anterior wall necrosis, and hypertension. In multivariable analysis, Nt-pro-BNP levels were negatively associated with creatinine clearance (P0.0001) and LVEF (P0.0001) and positively associated with plasma peak troponin (P0.0001), age (P=0.0029), diabetes (P=0.0031), and female gender (P=0.0102). Diabetic patients showed a 4.7-fold increase in hospital mortality (15.6 vs. 3.3%, P0.0001) and a 2.2-fold increase in cardiogenic shock (17.6 vs. 7.7%, P=0.0004). In multivariable analysis, diabetes was an independent factor for mortality [OR: 1.79 (1.45-2.20); P=0.0064] and cardiogenic shock [OR: 1.45 (1.22-1.72); P=0.0364] when the variable Nt-pro-BNP level was not introduced into the model, but was less significantly associated with mortality [OR: 1.73 (1.39-2.16); P=0.0107] and no longer associated with cardiogenic shock when Nt-pro-BNP was in the model.After MI, diabetes is independently associated with high plasma Nt-pro-BNP levels. This elevated Nt-pro-BNP is strongly associated with the increased incidence of in-hospital mortality and cardiogenic shock observed in diabetes. Our findings clearly indicate that plasma Nt-pro-BNP provides highly valuable prognostic information on in-hospital outcome after MI, in particular in diabetic patients. |
| Databáze: | OpenAIRE |
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