Zeng Rui-Xiang, Li Xiao-Lin, Zhang Min-Zhou, Wang Xiao-Wei, Guo Yuan-Lin, Zhu Cheng-Gang, Ren Yi, Li Sha, Zhang Yan, Liu Geng, Xu Rui-Xia, Dong Qian, Li Jian-Jun
a Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing , China.
Scand J Clin Lab Invest. 2015 Nov;75(7):568-77. doi: 10.3109/00365513.2015.1060518. Epub 2015 Jul 30.
Elevated preprocedural N-term pro-B-type natriuretic peptide (NT-pro-BNP) and postprocedural cardiac troponin I (cTnI) are related to a poor cardiac outcome in the non-diabetic population. We hypothesized that preprocedural NT-pro-BNP might be a useful marker in predicting periprocedural myocardial injury (PMI) following elective percutaneous coronary intervention (PCI) in type 2 diabetes (T2D).
We prospectively enrolled 1194 consecutive diabetic patients with normal cardiac function and preprocedural cTnI who were successfully undergoing elective PCI. Preprocedural NT-pro-BNP levels were assessed at admission, and PMI was evaluated by analysis of cTnI within 24 hours. The relationship between preprocedural NT-pro-BNP levels and the peak values of cTnI after PCI was examined.
Patients with high baseline NT-pro-BNP levels had higher postprocedural cTnI levels (β = 0.123, p < 0.001). In the multivariable model, NT-pro-BNP was associated with higher risk of postprocedural cTnI elevation above 1 × upper limit of normal (ULN, OR, 3.13; 95% CI, 1.51-6.50; p = 0.002), 3 × ULN (OR, 2.44; 95% CI, 1.17-5.08; p = 0.018), 5 × ULN (OR, 3.18; 95% CI, 1.44-7.0; p = 0.004), respectively. Moreover, the incidence of cTnI elevation was higher in patients with the upper tertile of NT-pro-BNP levels than that in ones with the lower tertile of NT-pro-BNP levels (> 1 × ULN: 63.1% vs. 50.0%, p < 0.001; > 3 × ULN: 39.2% vs. 31.9%, p = 0.032; > 5 × ULN: 30.4% vs. 21.9%, p < 0.006; respectively).
Our data, for the first time, demonstrated that increased preprocedural NT-pro-BNP levels were strongly and independently associated with a higher risk of PMI, suggesting that baseline NT-pro-BNP level might be a useful marker for predicting PMI following PCI in diabetic patients without cardiac dysfunction.
术前N端前脑钠肽原（NT-pro-BNP）升高及术后心肌肌钙蛋白I（cTnI）升高与非糖尿病患者不良心脏预后相关。我们推测，术前NT-pro-BNP可能是预测2型糖尿病（T2D）患者择期经皮冠状动脉介入治疗（PCI）围手术期心肌损伤（PMI）的有用标志物。
我们前瞻性纳入了1194例连续的心脏功能正常且术前cTnI正常的糖尿病患者，这些患者成功接受了择期PCI。入院时评估术前NT-pro-BNP水平，并通过分析24小时内的cTnI评估PMI。研究术前NT-pro-BNP水平与PCI术后cTnI峰值之间的关系。
基线NT-pro-BNP水平高的患者术后cTnI水平更高（β = 0.123，p < 0.001）。在多变量模型中，NT-pro-BNP与术后cTnI升高超过正常上限（ULN）1倍（OR，3.13；95%CI，1.51 - 6.50；p = 0.002）、3倍（OR，2.44；95%CI，1.17 - 5.08；p = 0.018）、5倍（OR，3.18；95%CI，1.44 - 7.0；p = 0.004）的较高风险相关。此外，NT-pro-BNP水平处于上三分位数的患者cTnI升高的发生率高于NT-pro-BNP水平处于下三分位数的患者（>1倍ULN：63.1%对50.0%，p < 0.001；>3倍ULN：39.2%对31.9%，p = 0.032；>5倍ULN：30.4%对21.9%，p < 0.006）。
我们的数据首次表明，术前NT-pro-BNP水平升高与PMI风险升高密切且独立相关，提示基线NT-pro-BNP水平可能是预测无心脏功能障碍的糖尿病患者PCI术后PMI的有用标志物。
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