title: Preprocedural N-terminal pro-B-type natriuretic peptide as a useful marker for predicting periprocedural myocardial injury following percutaneous coronary intervention in diabetic patients without cardiac dysfunction.
abstract: BACKGROUND
  Elevated preprocedural N-term pro-B-type natriuretic peptide (NT-pro-BNP) and postprocedural cardiac troponin I (cTnI) are related to a poor cardiac outcome in the non-diabetic population. We hypothesized that preprocedural NT-pro-BNP might be a useful marker in predicting periprocedural myocardial injury (PMI) following elective percutaneous coronary intervention (PCI) in type 2 diabetes (T2D).
  
  
  METHODS
  We prospectively enrolled 1194 consecutive diabetic patients with normal cardiac function and preprocedural cTnI who were successfully undergoing elective PCI. Preprocedural NT-pro-BNP levels were assessed at admission, and PMI was evaluated by analysis of cTnI within 24 hours. The relationship between preprocedural NT-pro-BNP levels and the peak values of cTnI after PCI was examined.
  
  
  RESULTS
  Patients with high baseline NT-pro-BNP levels had higher postprocedural cTnI levels (β = 0.123, p < 0.001). In the multivariable model, NT-pro-BNP was associated with higher risk of postprocedural cTnI elevation above 1 × upper limit of normal (ULN, OR, 3.13; 95% CI, 1.51-6.50; p = 0.002), 3 × ULN (OR, 2.44; 95% CI, 1.17-5.08; p = 0.018), 5 × ULN (OR, 3.18; 95% CI, 1.44-7.0; p = 0.004), respectively. Moreover, the incidence of cTnI elevation was higher in patients with the upper tertile of NT-pro-BNP levels than that in ones with the lower tertile of NT-pro-BNP levels (> 1 × ULN: 63.1% vs. 50.0%, p < 0.001; > 3 × ULN: 39.2% vs. 31.9%, p = 0.032; > 5 × ULN: 30.4% vs. 21.9%, p < 0.006; respectively).
  
  
  CONCLUSIONS
  Our data, for the first time, demonstrated that increased preprocedural NT-pro-BNP levels were strongly and independently associated with a higher risk of PMI, suggesting that baseline NT-pro-BNP level might be a useful marker for predicting PMI following PCI in diabetic patients without cardiac dysfunction.
authors.affiliation: a Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing , China.
authors.forename: Rui-Xiang
authors.initials: RX
authors.lastname: Zeng
authors.forename: Xiao-Lin
authors.initials: XL
authors.lastname: Li
authors.forename: Min-Zhou
authors.initials: MZ
authors.lastname: Zhang
authors.forename: Xiao-Wei
authors.initials: XW
authors.lastname: Wang
authors.forename: Yuan-Lin
authors.initials: YL
authors.lastname: Guo
authors.forename: Cheng-Gang
authors.initials: CG
authors.lastname: Zhu
authors.forename: Yi
authors.initials: Y
authors.lastname: Ren
authors.forename: Sha
authors.initials: S
authors.lastname: Li
authors.forename: Yan
authors.initials: Y
authors.lastname: Zhang
authors.forename: Geng
authors.initials: G
authors.lastname: Liu
authors.forename: Rui-Xia
authors.initials: RX
authors.lastname: Xu
authors.forename: Qian
authors.initials: Q
authors.lastname: Dong
authors.forename: Jian-Jun
authors.initials: JJ
authors.lastname: Li
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000150:complications; D006801:Humans; D007431:Intraoperative Complications / Q000097:blood*; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000097:blood; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D059035:Perioperative Period; D011379:Prognosis; D019210:Troponin I / Q000097:blood
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; D019210:Troponin I; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: N-term pro-B-type natriuretic peptide; coronary artery disease; percutaneous coronary intervention; periprocedural myocardial injury; type 2 diabetes