Role of B‐Type Natriuretic Peptide and N‐Terminal Prohormone BNP as Predictors of Cardiovascular Morbidity and Mortality in Patients With a Recent Coronary Event and Type 2 Diabetes Mellitus

Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease

Francesca C. Lawson¹  Jeffrey L. Probstfield²  Matthew C. Riddle³  Marc A. Pfeffer⁴  Jean‐Claude Tardif⁴  Emil Wolsk⁴  Aldo P. Maggioni⁴  Brian Claggett⁴  Hertzel C. Gerstein⁵  Scott D. Solomon⁶  Rafael Diaz⁷  Lars Køber⁸  John J. V. McMurray⁹  Eldrin F. Lewis^1,10  Kenneth Dickstein^1,11 

[1] Metabolism, McMaster University, Hamilton, Ontario, Canada;British Heart Foundation Cardiovascular Research Centre, University of Glasgow, United Kingdom;Division of Cardiology, University of Washington Medical Center, Seattle, WA;Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA;;Division of Endocrinology &Division of Endocrinology, Oregon Health and Science University, Portland, OR;Estudios Clínicos Latinoamérica, Rosario, Argentina;Montreal Heart Institute, Université de Montréal, Montreal, Canada;Research Center of the Italian Association of Hospital Cardiologists, Florence, Italy;Sanofi U.S., Bridgewater, NJ;University of Bergen Stavanger University Hospital, Stavanger, Norway;

关键词: acute coronary syndrome;    biomarker;    brain natriuretic peptide;    cardiac outcomes;    diabetes mellitus;    Evaluation of Lixisenatide in Acute Coronary Syndrome trial;   

DOI  :  10.1161/JAHA.116.004743

来源: DOAJ

【 摘 要 】

BackgroundNatriuretic peptides are recognized as important predictors of cardiovascular events in patients with heart failure, but less is known about their prognostic importance in patients with acute coronary syndrome. We sought to determine whether B‐type natriuretic peptide (BNP) and N‐terminal prohormone B‐type natriuretic peptide (NT‐proBNP) could enhance risk prediction of a broad range of cardiovascular outcomes in patients with acute coronary syndrome and type 2 diabetes mellitus. Methods and ResultsPatients with a recent acute coronary syndrome and type 2 diabetes mellitus were prospectively enrolled in the ELIXA trial (n=5525, follow‐up time 26 months). Best risk models were constructed from relevant baseline variables with and without BNP/NT‐proBNP. C statistics, Net Reclassification Index, and Integrated Discrimination Index were analyzed to estimate the value of adding BNP or NT‐proBNP to best risk models. Overall, BNP and NT‐proBNP were the most important predictors of all outcomes examined, irrespective of history of heart failure or any prior cardiovascular disease. BNP significantly improved C statistics when added to risk models for each outcome examined, the strongest increments being in death (0.77–0.82, P<0.001), cardiovascular death (0.77–0.83, P<0.001), and heart failure (0.84–0.87, P<0.001). BNP or NT‐proBNP alone predicted death as well as all other variables combined (0.77 versus 0.77). ConclusionsIn patients with a recent acute coronary syndrome and type 2 diabetes mellitus, BNP and NT‐proBNP were powerful predictors of cardiovascular outcomes beyond heart failure and death, ie, were also predictive of MI and stroke. Natriuretic peptides added as much predictive information about death as all other conventional variables combined. Clinical Trial RegistrationURL: http://www.clinicaltrials.gov. Unique identifier: NCT01147250.

【 授权许可】

Unknown