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European Heart Journal Advance Access published online on April 14, 2005
European Heart Journal, doi:10.1093/eurheartj/ehi260
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European Heart Journal © The European Society of Cardiology 2005; all rights reserved
Received October 11, 2004
Revised February 4, 2005
Accepted March 15, 2005

Clinical research

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

Bruno Vergès 1*, Marianne Zeller 2, Jean Desgrès 3, Gilles Dentan 4, Yves Laurent 5, Luc Janin-Manificat 6, Isabelle L'Huillier 2, Gilles Rioufol 2, Jean-Claude Beer 2, Hamid Makki 7, Luc Rochette 8, Philippe Gambert 3, Yves Cottin 2, and on behalf of RICO survey working group

1 Service Endocrinologie, Diabétologie, Hôpital du Bocage, CHU Dijon, Bd de Lattre de Tassigny, 21034 Dijon Cedex, France
2 Service de Cardiologie, CHU Bocage, Dijon, France
3 Laboratoire de Biochimie, CHU Bocage, Dijon, France
4 Service de Cardiologie, Clinique de Fontaine, Fontaine les Dijon, France
5 Service de Cardiologie, Centre Hospitalier, Semur en Auxois, France
6 Service de Cardiologie, Centre Hospitalier, Beaune, France
7 Service de Cardiologie, Centre Hospitalier, Châtillon sur Seine, France
8 Laboratoire de Physiologie et Pharmacologie Cardiovasculaire Expérimenale, Faculté de Médecine, Dijon, France

* To whom correspondence should be addressed.
Bruno Vergès, E-mail: bruno.verges{at}chu-dijon.fr


  Abstract

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.

Keywords: Diabetes; Myocardial infarction; Nt-pro-BNP; BNP; Ischaemia.
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