Emil Wolsk , MD, PhD 1 , 2 , Brian Claggett , PhD 1 , Marc A. Pfeffer , MD, PhD 1 , Rafael Diaz , MD 3 , Kenneth Dickstein , MD, PhD 4 , Hertzel C. Gerstein , MD 5 , Francesca C. Lawson , MD 6 , Eldrin F. Lewis , MD, MPH 1 , Aldo P. Maggioni , MD 7 , John J. V. McMurray , MD, PhD 8 , Jeffrey L. Probstfield , MD 9 , Matthew C. Riddle , MD 10 , Scott D. Solomon , MD 1 , Jean‐Claude Tardif , MD 11 , Lars Køber , MD , 2
29 May 2017
acute coronary syndrome, biomarker, brain natriuretic peptide, cardiac outcomes, diabetes mellitus, Evaluation of Lixisenatide in Acute Coronary Syndrome trial, glucagon‐like peptide‐1, natriuretic peptide, N‐terminal prohormone B‐type natriuretic peptide, risk model, Cardiovascular Disease, Epidemiology, Heart Failure, Diabetes, Type 2
Natriuretic peptides are recognized as important predictors of cardiovascular events in patients with heart failure, but less is known about their prognostic importance in patients with acute coronary syndrome. We sought to determine whether B‐type natriuretic peptide ( BNP) and N‐terminal prohormone B‐type natriuretic peptide ( NT‐pro BNP) could enhance risk prediction of a broad range of cardiovascular outcomes in patients with acute coronary syndrome and type 2 diabetes mellitus.
Patients with a recent acute coronary syndrome and type 2 diabetes mellitus were prospectively enrolled in the ELIXA trial (n=5525, follow‐up time 26 months). Best risk models were constructed from relevant baseline variables with and without BNP/ NT‐pro BNP. C statistics, Net Reclassification Index, and Integrated Discrimination Index were analyzed to estimate the value of adding BNP or NT‐pro BNP to best risk models. Overall, BNP and NT‐pro BNP were the most important predictors of all outcomes examined, irrespective of history of heart failure or any prior cardiovascular disease. BNP significantly improved C statistics when added to risk models for each outcome examined, the strongest increments being in death (0.77–0.82, P<0.001), cardiovascular death (0.77–0.83, P<0.001), and heart failure (0.84–0.87, P<0.001). BNP or NT‐pro BNP alone predicted death as well as all other variables combined (0.77 versus 0.77).
In patients with a recent acute coronary syndrome and type 2 diabetes mellitus, BNP and NT‐pro BNP were powerful predictors of cardiovascular outcomes beyond heart failure and death, ie, were also predictive of MI and stroke. Natriuretic peptides added as much predictive information about death as all other conventional variables combined.
URL: http://www.clinicaltrials.gov. Unique identifier: NCT01147250.