Wolsk Emil, Claggett Brian, Pfeffer Marc A, Diaz Rafael, Dickstein Kenneth, Gerstein Hertzel C, Lawson Francesca C, Lewis Eldrin F, Maggioni Aldo P, McMurray John J V, Probstfield Jeffrey L, Riddle Matthew C, Solomon Scott D, Tardif Jean-Claude, Køber Lars
Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.
J Am Heart Assoc. 2017 May 29;6(6):e004743. doi: 10.1161/JAHA.116.004743.
Natriuretic 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.
Patients 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, <0.001), cardiovascular death (0.77-0.83, <0.001), and heart failure (0.84-0.87, <0.001). BNP or NT-proBNP alone predicted death as well as all other variables combined (0.77 versus 0.77).
In 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.
URL: http://www.clinicaltrials.gov. Unique identifier: NCT01147250.
利钠肽被认为是心力衰竭患者心血管事件的重要预测指标，但关于其在急性冠状动脉综合征患者中的预后重要性知之甚少。我们试图确定B型利钠肽（BNP）和N末端B型利钠肽原（NT-proBNP）是否能增强急性冠状动脉综合征和2型糖尿病患者广泛心血管结局的风险预测。
近期发生急性冠状动脉综合征且患有2型糖尿病的患者前瞻性纳入ELIXA试验（n = 5525，随访时间26个月）。根据相关基线变量构建有和没有BNP/NT-proBNP的最佳风险模型。分析C统计量、净重新分类指数和综合判别指数，以评估将BNP或NT-proBNP添加到最佳风险模型中的价值。总体而言，无论有无心力衰竭病史或任何既往心血管疾病，BNP和NT-proBNP都是所有检查结局的最重要预测指标。将BNP添加到每个检查结局的风险模型中时，显著改善了C统计量，最大增幅出现在死亡（0.77 - 0.82，<0.001）、心血管死亡（0.77 - 0.83，<0.001）和心力衰竭（0.84 - 0.87，<0.001）方面。单独的BNP或NT-proBNP预测死亡的能力与所有其他变量组合相当（0.77对0.77）。
在近期发生急性冠状动脉综合征且患有2型糖尿病的患者中，BNP和NT-proBNP是心力衰竭和死亡以外心血管结局的有力预测指标，即也能预测心肌梗死和中风。利钠肽添加的关于死亡的预测信息与所有其他传统变量组合相当。
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