title: High plasma N-terminal pro-brain natriuretic peptide level found in diabetic patients after myocardial infarction is associated with an increased risk of in-hospital mortality and cardiogenic shock.
abstract: OBJECTIVE
  No studies have yet been conducted concerning plasma N-terminal pro-brain natriuretic peptide (Nt-pro-BNP) levels after Myocardial Infarction (MI) and their relationship with short-term outcomes in diabetic patients.
  
  
  RESULTS
  Five hundred and sixty patients hospitalized for MI from the RICO survey, including 199 diabetic and 361 non-diabetic subjects, were included in the study. Plasma Nt-pro-BNP levels were measured on admission. Median Nt-pro-BNP levels were significantly higher in diabetic patients compared with non-diabetic patients [245 (81-77) vs. 130 (49-199) pmol/L, P<0.0001]. This difference remained highly significant after adjustment for age, female gender, creatinine clearance, left ventricular ejection fraction (LVEF), plasma peak troponin, anterior wall necrosis, and hypertension. In multivariable analysis, Nt-pro-BNP levels were negatively associated with creatinine clearance (P<0.0001) and LVEF (P<0.0001) and positively associated with plasma peak troponin (P<0.0001), age (P=0.0029), diabetes (P=0.0031), and female gender (P=0.0102). Diabetic patients showed a 4.7-fold increase in hospital mortality (15.6 vs. 3.3%, P<0.0001) and a 2.2-fold increase in cardiogenic shock (17.6 vs. 7.7%, P=0.0004). In multivariable analysis, diabetes was an independent factor for mortality [OR: 1.79 (1.45-2.20); P=0.0064] and cardiogenic shock [OR: 1.45 (1.22-1.72); P=0.0364] when the variable Nt-pro-BNP level was not introduced into the model, but was less significantly associated with mortality [OR: 1.73 (1.39-2.16); P=0.0107] and no longer associated with cardiogenic shock when Nt-pro-BNP was in the model.
  
  
  CONCLUSIONS
  After MI, diabetes is independently associated with high plasma Nt-pro-BNP levels. This elevated Nt-pro-BNP is strongly associated with the increased incidence of in-hospital mortality and cardiogenic shock observed in diabetes. Our findings clearly indicate that plasma Nt-pro-BNP provides highly valuable prognostic information on in-hospital outcome after MI, in particular in diabetic patients.
authors.affiliation: Service d'Endocrinologie, Hôpital du Bocage, CHU Dijon, Boulevard de Lattre de Tassigny, 21034 Dijon Cedex, France. bruno.verges@chu-dijon.fr
authors.forename: Bruno
authors.initials: B
authors.lastname: Vergès
authors.forename: Marianne
authors.initials: M
authors.lastname: Zeller
authors.forename: Jean
authors.initials: J
authors.lastname: Desgrès
authors.forename: Gilles
authors.initials: G
authors.lastname: Dentan
authors.forename: Yves
authors.initials: Y
authors.lastname: Laurent
authors.forename: Luc
authors.initials: L
authors.lastname: Janin-Manificat
authors.forename: Isabelle
authors.initials: I
authors.lastname: L'Huillier
authors.forename: Gilles
authors.initials: G
authors.lastname: Rioufol
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Beer
authors.forename: Hamid
authors.initials: H
authors.lastname: Makki
authors.forename: Luc
authors.initials: L
authors.lastname: Rochette
authors.forename: Philippe
authors.initials: P
authors.lastname: Gambert
authors.forename: Yves
authors.initials: Y
authors.lastname: Cottin
mesh_terms: D000367:Age Factors; D000368:Aged; D015415:Biomarkers / Q000097:blood; D003925:Diabetic Angiopathies / Q000097:blood* / Q000150:complications; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000150:complications; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D012008:Recurrence; D012737:Sex Factors; D012770:Shock, Cardiogenic / Q000097:blood* / Q000209:etiology; D013318:Stroke Volume
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain