European Heart Journal Advance Access originally published online on April 14, 2005
European Heart Journal 2005 26(17):1734-1741; doi:10.1093/eurheartj/ehi260
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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
1Service d'Endocrinologie, CHU Bocage, Dijon, France
2Service de Cardiologie, CHU Bocage, Dijon, France
3Laboratoire de Biochimie, CHU Bocage, Dijon, France
4Service de Cardiologie, Clinique de Fontaine, Fontaine les Dijon, France
5Service de Cardiologie, Centre Hospitalier, Semur en Auxois, France
6Service de Cardiologie, Centre Hospitalier, Beaune, France
7Service de Cardiologie, Centre Hospitalier, Châtillon sur Seine, France
8Laboratoire de Physiologie et Pharmacologie Cardiovasculaire Expérimenale, Faculté de Médecine, Dijon, France
Received 11 October 2004; revised 4 February 2005; accepted 15 March 2005; online publish-ahead-of-print 14 April 2005.
* Corresponding author: Service Endocrinologie, Diabétologie, Hôpital du Bocage, CHU Dijon, Bd de Lattre de Tassigny, 21034 Dijon Cedex, France. Tel: +3 8029 3453; fax: +3 8029 3519. E-mail address: bruno.verges{at}chu-dijon.fr
Aims 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.
Methods and results 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, P<0.0001]. 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 (P<0.0001) and LVEF (P<0.0001) and positively associated with plasma peak troponin (P<0.0001), 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%, P<0.0001) 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.
Conclusion 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.
Key Words: Diabetes • Myocardial infarction • Nt-pro-BNP • BNP • Ischaemia
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