Department of Clinical Research and Development, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shinmachi, Suita, Osaka, Japan.
Kim Cardiovascular Clinic, 3-6-8 Katsuyama, Tennoji-ku, Osaka, Japan.
Cardiovasc Drugs Ther. 2020 Feb;34(1):79-88. doi: 10.1007/s10557-019-06922-9.
Although impaired glucose tolerance (IGT) promotes cardiovascular events, our Alpha-glucosidase-inhibitor Blocks Cardiac Events in Patients with Myocardial Infarction and Impaired Glucose Tolerance (ABC) study showed that alpha-glucosidase inhibitors do not prevent cardiovascular events in patients with myocardial infarction (MI) and IGT. The aim of the present study was to identify potential clinical factors for cardiovascular events in patients with MI and IGT.
Using the limitless-arity multiple testing procedure, an artificial intelligence (AI)-based data mining method, we analyzed 385,391 combinations of fewer than four clinical parameters.
We identified 380 combinations predicting the occurrence of (1) all-cause hospitalization, (2) hospitalization due to worsening of heart failure (HF), (3) hospitalization due to non-fatal MI, and (4) hospitalization due to percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) for stable angina among 385,391 combinations in 853 patients. Among these, either plasma BNP levels ≥ 200 pg/dl or diuretic use exclusively predicted (1) all-cause hospitalization, (2) hospitalization due to worsening of HF, and (3) hospitalization due to a non-fatal MI, with plasma BNP levels ≥ 200 pg/dl being the sole predictor of hospitalization due to PCI and CABG. Importantly, each finding was verified by independently drawn Kaplan-Meier curves, revealing the unexpected role of plasma BNP levels in the progression of coronary stenosis determined as the necessity of PCI and CABG for stable angina.
In patients with MI and IGT, high plasma BNP levels predicted the occurrence of coronary stenosis, recurrent MI, and worsening of HF, whereas diuretic use did not predict the progression of coronary stenosis but non-fatal MI and worsening of HF.
尽管糖耐量受损（IGT）会促进心血管事件的发生，但我们的 Alpha-葡萄糖苷酶抑制剂阻断心肌梗死和糖耐量受损患者的心血管事件（ABC）研究表明，alpha-葡萄糖苷酶抑制剂不能预防心肌梗死（MI）和 IGT 患者的心血管事件。本研究旨在确定 MI 和 IGT 患者发生心血管事件的潜在临床因素。
使用无界性多重检验程序，一种基于人工智能（AI）的数据挖掘方法，我们分析了少于四个临床参数的 385391 种组合。
我们在 853 名患者中，从 385391 种组合中确定了 380 种组合，这些组合可以预测以下情况的发生：（1）全因住院、（2）因心力衰竭恶化（HF）住院、（3）非致命性心肌梗死住院，以及（4）因稳定型心绞痛进行经皮冠状动脉介入治疗（PCI）和冠状动脉旁路移植术（CABG）的住院。其中，要么血浆 BNP 水平≥200pg/dl，要么仅使用利尿剂，可以预测（1）全因住院、（2）因 HF 恶化住院和（3）非致命性 MI 住院，血浆 BNP 水平≥200pg/dl 是 PCI 和 CABG 治疗的唯一预测因素。重要的是，每个发现都通过独立绘制的 Kaplan-Meier 曲线得到了验证，揭示了血浆 BNP 水平在确定 PCI 和 CABG 治疗稳定型心绞痛的必要性时对冠状动脉狭窄进展的意外作用。
在 MI 和 IGT 患者中，高血浆 BNP 水平预测了冠状动脉狭窄、复发性 MI 和 HF 恶化的发生，而利尿剂的使用并未预测冠状动脉狭窄的进展，但预测了非致命性 MI 和 HF 恶化的发生。
