Department of Internal Medicine I, University Hospital Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
Clinic for Internal Medicine II, Staedtisches Klinikum Dessau, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Auenweg 38, 06847, Dessau-Rosslau, Germany.
Clin Res Cardiol. 2024 Aug;113(8):1211-1218. doi: 10.1007/s00392-023-02366-2. Epub 2024 Jan 3.
Glucagon-like peptide-1 (GLP-1) is a gut-derived peptide secreted in response to nutritional and inflammatory stimuli. Elevated GLP-1 levels predict adverse outcome in patients with acute myocardial infarction or sepsis. GLP-1 holds cardioprotective effects and GLP-1 receptor agonists reduce cardiovascular events in high-risk patients with diabetes. In this study, we aimed to investigate the capacity of GLP-1 to predict outcome in patients with cardiogenic shock (CS) complicating myocardial infarction.
Circulating GLP-1 levels were serially assessed in 172 individuals during index PCI and day 2 in a prospectively planned biomarker substudy of the IABP-SHOCK II trial. All-cause mortality at short- (30 days), intermediate- (1 year), and long-term (6 years) follow-up was used for outcome assessment.
Patients with fatal short-term outcome (n = 70) exhibited higher GLP-1 levels [86 (interquartile range 45-130) pM] at ICU admission in comparison to patients with 30-day survival [48 (interquartile range 33-78) pM; p < 0.001] (n = 102). Repeated measures ANOVA revealed a significant interaction of GLP-1 dynamics from baseline to day 2 between survivors and non-survivors (p = 0.04). GLP-1 levels above vs. below the median proved to be predictive for short- [hazard ratio (HR) 2.43; 95% confidence interval (CI) 1.50-3.94; p < 0.001], intermediate- [HR 2.46; 95% CI 1.62-3.76; p < 0.001] and long-term [HR 2.12; 95% CI 1.44-3.11; p < 0.001] outcome by multivariate Cox-regression analysis.
Elevated plasma levels of GLP-1 are an independent predictor for impaired prognosis in patients with myocardial infarction complicated by CS. The functional relevance of GLP-1 in this context is currently unknown and needs further investigations.
www.
gov Identifier: NCT00491036.
胰高血糖素样肽-1（GLP-1）是一种肠道来源的肽，在营养和炎症刺激下分泌。在急性心肌梗死或脓毒症患者中，升高的 GLP-1 水平预示着不良结局。GLP-1 具有心脏保护作用，GLP-1 受体激动剂可降低高危糖尿病患者的心血管事件风险。在这项研究中，我们旨在研究 GLP-1 预测并发心肌梗死的心源性休克（CS）患者结局的能力。
在 IABP-SHOCK II 试验的前瞻性生物标志物亚研究中，172 名患者在指数 PCI 期间和第 2 天连续评估循环 GLP-1 水平。短期（30 天）、中期（1 年）和长期（6 年）随访的全因死亡率用于结局评估。
与 30 天存活的患者[48（四分位距 33-78）pM；p<0.001]相比，短期死亡的患者（n=70）在 ICU 入院时的 GLP-1 水平更高[86（四分位距 45-130）pM；p<0.001]。重复测量方差分析显示，幸存者和非幸存者之间从基线到第 2 天的 GLP-1 动态存在显著交互作用（p=0.04）。GLP-1 水平高于或低于中位数可预测短期[危险比（HR）2.43；95%置信区间（CI）1.50-3.94；p<0.001]、中期[HR 2.46；95% CI 1.62-3.76；p<0.001]和长期[HR 2.12；95% CI 1.44-3.11；p<0.001]结局，这是通过多变量 Cox 回归分析得出的。
血浆中 GLP-1 水平升高是并发 CS 的心肌梗死患者预后不良的独立预测因子。GLP-1 在这种情况下的功能相关性尚不清楚，需要进一步研究。
www.
gov 标识符：NCT00491036。
