Farhan Serdar, Clare Robert M, Jarai Rudolf, Giugliano Robert P, Lokhnygina Yuliya, Harrington Robert A, Kristin Newby L, Huber Kurt
3rd Department of Internal Medicine, Cardiology, and Intensive Care Medicine, Wilhelminen Hospital, Vienna, Austria.
Duke Clinical Research Institute, Durham, NC, USA.
Int J Cardiol. 2017 Apr 1;232:264-270. doi: 10.1016/j.ijcard.2017.01.007. Epub 2017 Jan 4.
Higher N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels have been linked to a more favorable glucometabolic profile. Little is known about the interaction of NT-proBNP and fasting glucose in non-ST-segment elevation acute coronary syndrome (NSTE ACS).
Fasting glucose and NT-proBNP were measured in 2240 patients enrolled in the EARLY ACS trial. Multivariable Cox models were used to assess associations between fasting glucose and NT-proBNP and a 96-hour composite of death, myocardial infarction (MI), recurrent ischemia, or thrombotic bailout; 30-day death or MI; and 1-year mortality.
In adjusted Cox models, neither NT-proBNP nor fasting glucose was associated with the 96-hour endpoint (p=0.95 and p=0.87). NT-proBNP was associated with 30-day death or MI (hazard ratio [HR] 1.11, 95% confidence interval [CI] 1.02-1.22, p=0.02) and 1-year mortality (HR 1.63, 95% CI 1.42-1.89, p<0.0001), but fasting glucose was associated only with 1-year death (HR 1.53, 95% CI 1.08-2.16, p=0.02). NT-proBNP×glucose interaction terms were non-significant in all models. As fasting glucose levels increased, the risk of 96-hour and 30-day endpoints increased among patients who received early eptifibatide but not delayed, provisional use (p=0.035 and p=0.029). Higher NT-proBNP levels were associated with greater 30-day death or MI among patients who received early eptifibatide but not delayed, provisional use (p=0.045).
NT-proBNP and fasting glucose concentrations were associated with intermediate-term ischemic outcomes and may identify differential response to treatment with eptifibatide. CLINICALTRIALS.
NCT00089895.
较高的N末端B型利钠肽原（NT-proBNP）水平与更有利的糖代谢状况相关。关于NT-proBNP与非ST段抬高型急性冠状动脉综合征（NSTE ACS）患者空腹血糖之间的相互作用，目前所知甚少。
在参与EARLY ACS试验的2240例患者中测量空腹血糖和NT-proBNP。采用多变量Cox模型评估空腹血糖与NT-proBNP和96小时复合终点（死亡、心肌梗死（MI）、再发缺血或血栓形成补救）、30天死亡或MI以及1年死亡率之间的关联。
在调整后的Cox模型中，NT-proBNP和空腹血糖均与96小时终点无关（p = 0.95和p = 0.87）。NT-proBNP与30天死亡或MI相关（风险比[HR] 1.11，95%置信区间[CI] 1.02 - 1.22，p = 0.02）以及1年死亡率相关（HR 1.63，95% CI 1.42 - 1.89，p < 0.0001），但空腹血糖仅与1年死亡相关（HR 1.53，95% CI 1.08 - 2.16，p = 0.02）。NT-proBNP×血糖交互项在所有模型中均无统计学意义。随着空腹血糖水平升高，在接受早期依替巴肽而非延迟临时使用的患者中，96小时和30天终点的风险增加（p = 0.035和p = 0.029）。在接受早期依替巴肽而非延迟临时使用的患者中，较高的NT-proBNP水平与30天死亡或MI风险增加相关（p = 0.045）。
NT-proBNP和空腹血糖浓度与中期缺血性结局相关，并且可能有助于识别对依替巴肽治疗的不同反应。临床试验。
NCT00089895。
