Abstract
BackgroundThe prognostic value of N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with coronary artery disease (CAD) with different glucose status has not been established. This study sought to evaluate the significance of NT-proBNP in predicting major adverse cardiovascular events (MACEs) in patients with chronic coronary syndrome (CCS) and normal left-ventricular systolic function (LVSF) according to different glucose status, especially in those with abnormal glucose metabolism.Methods A total of 8062 patients with CCS and normal LVSF were consecutively enrolled in this prospective study. Baseline plasma NT-proBNP levels were measured. The follow-up data of all patients were collected. Kaplan-Meier and Cox regression analyses were used to assess the risk of MACEs according to NT-proBNP tertiles stratified by glucose status.ResultsOver an average follow-up of 59.13 ± 18.23 months, 569 patients (7.1 %) suffered from MACEs, including cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke. Kaplan-Meier analysis showed that high NT-proBNP levels had a significant association with MACEs in subjects with prediabetes mellitus (pre-DM) or DM, but not in patients with normoglycemia. Multivariate Cox regression analysis revealed that NT-proBNP remained an independent predictor of MACEs in patients with pre-DM [hazard ratio (HR): 2.56, 95% confidence interval (CI): 1.34–4.91] or DM (HR: 2.34, 95% CI: 1.32–4.16). Moreover, adding NT-proBNP to the original Cox model including traditional risk factors significantly increased the C-statistic by 0.035 in pre-DM and DM, respectively.ConclusionsThe present study indicated that NT-proBNP could well predict worse outcomes in dysglycemic patients with CCS and normal LVSF, suggesting that NT-proBNP may help with risk stratification in this population.
Highlights
The prognostic value of N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with coronary artery disease (CAD) with different glucose status has not been established
NT-proBNP was suggested to be a strong predictor for mortality and cardiovascular events (CVEs) in the general population [9,10,11], patients with diabetes mellitus (DM) [2, 4, 12,13,14,15], acute coronary syndrome (ACS) [14], and chronic coronary syndrome (CCS) [16, 17]
Baseline characteristics Among the subjects, 41.8% were defined as pre-DM, 36.6% had DM, and the rest 21.6% were with normoglycemia (Fig. 1)
Summary
The prognostic value of N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with coronary artery disease (CAD) with different glucose status has not been established. This study sought to evaluate the sig‐ nificance of NT-proBNP in predicting major adverse cardiovascular events (MACEs) in patients with chronic coronary syndrome (CCS) and normal left-ventricular systolic function (LVSF) according to different glucose status, especially in those with abnormal glucose metabolism. A recently published study showed that NT-proBNP was a useful biomarker of cardiac conditions in patients undergoing left ventricular assist device implantation [8]. NT-proBNP was suggested to be a strong predictor for mortality and cardiovascular events (CVEs) in the general population [9,10,11], patients with diabetes mellitus (DM) [2, 4, 12,13,14,15], acute coronary syndrome (ACS) [14], and chronic coronary syndrome (CCS) [16, 17]. Further exploration of the application value of NTproBNP in wider populations has become a hot topic in cardiovascular field
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