title: Fasting glucose, NT-proBNP, treatment with eptifibatide, and outcomes in non-ST-segment elevation acute coronary syndromes: An analysis from EARLY ACS.
abstract: BACKGROUND
  Higher N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels have been linked to a more favorable glucometabolic profile. Little is known about the interaction of NT-proBNP and fasting glucose in non-ST-segment elevation acute coronary syndrome (NSTE ACS).
  
  
  METHODS
  Fasting glucose and NT-proBNP were measured in 2240 patients enrolled in the EARLY ACS trial. Multivariable Cox models were used to assess associations between fasting glucose and NT-proBNP and a 96-hour composite of death, myocardial infarction (MI), recurrent ischemia, or thrombotic bailout; 30-day death or MI; and 1-year mortality.
  
  
  RESULTS
  In adjusted Cox models, neither NT-proBNP nor fasting glucose was associated with the 96-hour endpoint (p=0.95 and p=0.87). NT-proBNP was associated with 30-day death or MI (hazard ratio [HR] 1.11, 95% confidence interval [CI] 1.02-1.22, p=0.02) and 1-year mortality (HR 1.63, 95% CI 1.42-1.89, p<0.0001), but fasting glucose was associated only with 1-year death (HR 1.53, 95% CI 1.08-2.16, p=0.02). NT-proBNP×glucose interaction terms were non-significant in all models. As fasting glucose levels increased, the risk of 96-hour and 30-day endpoints increased among patients who received early eptifibatide but not delayed, provisional use (pint=0.035 and pint=0.029). Higher NT-proBNP levels were associated with greater 30-day death or MI among patients who received early eptifibatide but not delayed, provisional use (pint=0.045).
  
  
  CONCLUSIONS
  NT-proBNP and fasting glucose concentrations were associated with intermediate-term ischemic outcomes and may identify differential response to treatment with eptifibatide. CLINICALTRIALS.
  NCT00089895.
authors.affiliation: 3rd Department of Internal Medicine, Cardiology, and Intensive Care Medicine, Wilhelminen Hospital, Vienna, Austria.
authors.forename: Serdar
authors.initials: S
authors.lastname: Farhan
authors.affiliation: Duke Clinical Research Institute, Durham, NC, USA.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Clare
authors.affiliation: 3rd Department of Internal Medicine, Cardiology, and Intensive Care Medicine, Wilhelminen Hospital, Vienna, Austria.
authors.forename: Rudolf
authors.initials: R
authors.lastname: Jarai
authors.affiliation: TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Robert P
authors.initials: RP
authors.lastname: Giugliano
authors.affiliation: Duke Clinical Research Institute, Durham, NC, USA.
authors.forename: Yuliya
authors.initials: Y
authors.lastname: Lokhnygina
authors.affiliation: Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Harrington
authors.affiliation: Duke Clinical Research Institute, Durham, NC, USA.
authors.forename: L
authors.initials: L
authors.lastname: Kristin Newby
authors.affiliation: 3rd Department of Internal Medicine, Cardiology, and Intensive Care Medicine, Wilhelminen Hospital, Vienna, Austria. Electronic address: kurt.huber@meduniwien.ac.at.
authors.forename: Kurt
authors.initials: K
authors.lastname: Huber
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood* / Q000175:diagnosis / Q000628:therapy; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism*; D017023:Coronary Angiography; D004305:Dose-Response Relationship, Drug; D004562:Electrocardiography; D000077542:Eptifibatide; D005215:Fasting / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D010455:Peptides / Q000008:administration & dosage*; D062645:Percutaneous Coronary Intervention; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D010446:Peptide Fragments; D010455:Peptides; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D000077542:Eptifibatide
keywords: Acute coronary syndrome; Eptifibatide; Fasting glucose; Glycoprotein IIb/IIIa inhibitor; NT-proBNP