title: Usefulness of biomarkers for predicting long-term mortality in patients with diabetes mellitus and non-ST-elevation acute coronary syndromes (a GUSTO IV substudy).
abstract: The present study evaluated whether biomarkers of ischemia, inflammation, myocardial damage, and dysfunction are equally useful in patients who have diabetes mellitus (DM) for prediction of cardiac events in non-ST-elevation acute coronary syndrome (ACS). DM was present in 1,677 of 7,800 patients (21.5%) who had non-ST-elevation ACS and were included in the Fourth Global Utilization of Strategies To Open Occluded Arteries (GUSTO IV) trial. Creatinine, N-terminal pro-B-type natriuretic peptide (NT-pro-BNP), troponin T, C-reactive protein, and interleukin-6 were analyzed in serum samples that were obtained at a median of 9.5 hours from symptom onset. One-year mortality rates were 13.5% among patients who had DM (n = 227) and 6.9% among those who did not (n = 418, p < 0.001). The median level of NT-pro-BNP was 2 times as high in patients who had DM, whereas troponin T levels did not differ by DM status. Mortality increased with ascending quartiles of NT-pro-BNP, with 1-year mortality rates of 3.9% (n = 11) in the bottom quartile and 29% (n = 103) in the top quartile. In multivariable analyses, factors that were predictive of 1-year mortality in patients who did not have DM were also significant for those who did. Presence of ST depression > 0.5 mm had the highest odds ratio of 2.3 (95% confidence interval 1.2 to 4.6). NT-pro-BNP levels > 669 ng/L (odds ratio 2.0, 95% confidence interval 1.1 to 3.6) and interleukin-6 levels > 10 ng/L (odds ratio 1.9, 95% confidence interval 1.2 to 3.0) were significant biomarker predictors. In conclusion, DM confers a high long-term mortality in non-ST-elevation ACS. Despite a larger proportion of ST depression and increased levels of NT-pro-BNP and interleukin-6 at admission, these factors provide independent prognostic information that may improve risk stratification and guidance of treatment.
authors.affiliation: Department of Medical Sciences and Cardiology, Academic Hospital, Uppsala, Sweden. stefan.james@akademiska.se
authors.forename: Stefan K
authors.initials: SK
authors.lastname: James
authors.forename: Bertil
authors.initials: B
authors.lastname: Lindahl
authors.forename: Jorik R
authors.initials: JR
authors.lastname: Timmer
authors.forename: Jan Paul
authors.initials: JP
authors.lastname: Ottervanger
authors.forename: Agneta
authors.initials: A
authors.lastname: Siegbahn
authors.forename: Mats
authors.initials: M
authors.lastname: Stridsberg
authors.forename: Paul
authors.initials: P
authors.lastname: Armstrong
authors.forename: Robert
authors.initials: R
authors.lastname: Califf
authors.forename: Lars
authors.initials: L
authors.lastname: Wallentin
authors.forename: Maarten L
authors.initials: ML
authors.lastname: Simoons
mesh_terms: D000368:Aged; D015415:Biomarkers; D002097:C-Reactive Protein; D003920:Diabetes Mellitus / Q000097:blood / Q000401:mortality*; D003925:Diabetic Angiopathies / Q000097:blood / Q000401:mortality*; D005260:Female; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000401:mortality*; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D013577:Syndrome; D020107:Troponin T
chemical_list: D015415:Biomarkers; D015850:Interleukin-6; D010446:Peptide Fragments; D020107:Troponin T; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D002097:C-Reactive Protein