Prognostic Value of NT-proBNP in Pre-Diabetic Patients With Stable Coronary Artery Disease and Normal Left Ventricular Systolic Function

Abstract

Background: Currently, no data is available regarding the predictive role of N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with prediabetes mellitus (pre-DM) and coronary artery disease (CAD). We aimed to evaluate the significance of NT-proBNP in predicting major adverse cardiovascular events (MACEs) in patients with stable CAD (SCAD) and normal left-ventricular systolic function (LVSF) according to different glucose status, especially in ones with pre-DM. Methods: In this prospective study, a total of 8062 patients with SCAD and normal LVSF were consecutively enrolled. They were categorized according to glucose status and further stratified by NT-proBNP tertiles. The follow-up data of all patients were collected. Findings: Over an average follow-up of 59·13±18·23 months, 569 patients suffered from MACEs, including cardiovascular death, non-fatal myocardial infarction, and stroke. Kaplan-Meier analysis showed that high NT-proBNP levels had a significant association with MACEs in subjects with pre-DM or DM (both p 0·05). Multivariate Cox regression analysis suggested that NT-proBNP remained an independent predictor for MACEs in patients with pre-DM [hazard ratio (HR): 2·68, 95% confidence interval (CI): 1·72-4·19] or DM (HR: 2·32, 95% CI: 1·55-3·51). Moreover, adding NT-proBNP to the original model increased the C-statistic by 0·024 and 0·036 in pre-DM and DM respectively (both p<0·05). Interpretation: Our data firstly indicated that NT-proBNP could well predict worse outcomes in pre-diabetic patients with SCAD and normal LVSF, suggesting that it may help identify patients with dysglycemia at extremely high risk. Funding Statement: Capital Health Development Fund; CAMS Major Collaborative Innovation Project. Declaration of Interests: The authors declare that there is no conflict of interest. Ethics Approval Statement: This study complied with the Declaration of Helsinki and was approved by the hospital’s ethical review board (FuWai Hospital & National Center for Cardiovascular Diseases, Beijing, China). Each participant provided written, informed consent before enrollment.