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Usefulness of biomarkers for predicting long-term mortality in patients with diabetes mellitus and non-ST-elevation acute coronary syndromes (a GUSTO IV substudy).
Am J Cardiol 2006; 97(2):167-72AJ

Abstract

The present study evaluated whether biomarkers of ischemia, inflammation, myocardial damage, and dysfunction are equally useful in patients who have diabetes mellitus (DM) for prediction of cardiac events in non-ST-elevation acute coronary syndrome (ACS). DM was present in 1,677 of 7,800 patients (21.5%) who had non-ST-elevation ACS and were included in the Fourth Global Utilization of Strategies To Open Occluded Arteries (GUSTO IV) trial. Creatinine, N-terminal pro-B-type natriuretic peptide (NT-pro-BNP), troponin T, C-reactive protein, and interleukin-6 were analyzed in serum samples that were obtained at a median of 9.5 hours from symptom onset. One-year mortality rates were 13.5% among patients who had DM (n = 227) and 6.9% among those who did not (n = 418, p < 0.001). The median level of NT-pro-BNP was 2 times as high in patients who had DM, whereas troponin T levels did not differ by DM status. Mortality increased with ascending quartiles of NT-pro-BNP, with 1-year mortality rates of 3.9% (n = 11) in the bottom quartile and 29% (n = 103) in the top quartile. In multivariable analyses, factors that were predictive of 1-year mortality in patients who did not have DM were also significant for those who did. Presence of ST depression > 0.5 mm had the highest odds ratio of 2.3 (95% confidence interval 1.2 to 4.6). NT-pro-BNP levels > 669 ng/L (odds ratio 2.0, 95% confidence interval 1.1 to 3.6) and interleukin-6 levels > 10 ng/L (odds ratio 1.9, 95% confidence interval 1.2 to 3.0) were significant biomarker predictors. In conclusion, DM confers a high long-term mortality in non-ST-elevation ACS. Despite a larger proportion of ST depression and increased levels of NT-pro-BNP and interleukin-6 at admission, these factors provide independent prognostic information that may improve risk stratification and guidance of treatment.

Authors+Show Affiliations

Department of Medical Sciences and Cardiology, Academic Hospital, Uppsala, Sweden. stefan.james@akademiska.seNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16442356

Citation

James, Stefan K., et al. "Usefulness of Biomarkers for Predicting Long-term Mortality in Patients With Diabetes Mellitus and non-ST-elevation Acute Coronary Syndromes (a GUSTO IV Substudy)." The American Journal of Cardiology, vol. 97, no. 2, 2006, pp. 167-72.
James SK, Lindahl B, Timmer JR, et al. Usefulness of biomarkers for predicting long-term mortality in patients with diabetes mellitus and non-ST-elevation acute coronary syndromes (a GUSTO IV substudy). Am J Cardiol. 2006;97(2):167-72.
James, S. K., Lindahl, B., Timmer, J. R., Ottervanger, J. P., Siegbahn, A., Stridsberg, M., ... Simoons, M. L. (2006). Usefulness of biomarkers for predicting long-term mortality in patients with diabetes mellitus and non-ST-elevation acute coronary syndromes (a GUSTO IV substudy). The American Journal of Cardiology, 97(2), pp. 167-72.
James SK, et al. Usefulness of Biomarkers for Predicting Long-term Mortality in Patients With Diabetes Mellitus and non-ST-elevation Acute Coronary Syndromes (a GUSTO IV Substudy). Am J Cardiol. 2006 Jan 15;97(2):167-72. PubMed PMID: 16442356.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Usefulness of biomarkers for predicting long-term mortality in patients with diabetes mellitus and non-ST-elevation acute coronary syndromes (a GUSTO IV substudy). AU - James,Stefan K, AU - Lindahl,Bertil, AU - Timmer,Jorik R, AU - Ottervanger,Jan Paul, AU - Siegbahn,Agneta, AU - Stridsberg,Mats, AU - Armstrong,Paul, AU - Califf,Robert, AU - Wallentin,Lars, AU - Simoons,Maarten L, Y1 - 2005/11/21/ PY - 2005/04/04/received PY - 2005/08/04/revised PY - 2005/08/04/accepted PY - 2006/1/31/pubmed PY - 2006/3/4/medline PY - 2006/1/31/entrez SP - 167 EP - 72 JF - The American journal of cardiology JO - Am. J. Cardiol. VL - 97 IS - 2 N2 - The present study evaluated whether biomarkers of ischemia, inflammation, myocardial damage, and dysfunction are equally useful in patients who have diabetes mellitus (DM) for prediction of cardiac events in non-ST-elevation acute coronary syndrome (ACS). DM was present in 1,677 of 7,800 patients (21.5%) who had non-ST-elevation ACS and were included in the Fourth Global Utilization of Strategies To Open Occluded Arteries (GUSTO IV) trial. Creatinine, N-terminal pro-B-type natriuretic peptide (NT-pro-BNP), troponin T, C-reactive protein, and interleukin-6 were analyzed in serum samples that were obtained at a median of 9.5 hours from symptom onset. One-year mortality rates were 13.5% among patients who had DM (n = 227) and 6.9% among those who did not (n = 418, p < 0.001). The median level of NT-pro-BNP was 2 times as high in patients who had DM, whereas troponin T levels did not differ by DM status. Mortality increased with ascending quartiles of NT-pro-BNP, with 1-year mortality rates of 3.9% (n = 11) in the bottom quartile and 29% (n = 103) in the top quartile. In multivariable analyses, factors that were predictive of 1-year mortality in patients who did not have DM were also significant for those who did. Presence of ST depression > 0.5 mm had the highest odds ratio of 2.3 (95% confidence interval 1.2 to 4.6). NT-pro-BNP levels > 669 ng/L (odds ratio 2.0, 95% confidence interval 1.1 to 3.6) and interleukin-6 levels > 10 ng/L (odds ratio 1.9, 95% confidence interval 1.2 to 3.0) were significant biomarker predictors. In conclusion, DM confers a high long-term mortality in non-ST-elevation ACS. Despite a larger proportion of ST depression and increased levels of NT-pro-BNP and interleukin-6 at admission, these factors provide independent prognostic information that may improve risk stratification and guidance of treatment. SN - 0002-9149 UR - https://www.unboundmedicine.com/medline/citation/16442356/Usefulness_of_biomarkers_for_predicting_long_term_mortality_in_patients_with_diabetes_mellitus_and_non_ST_elevation_acute_coronary_syndromes__a_GUSTO_IV_substudy__ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9149(05)01795-9 DB - PRIME DP - Unbound Medicine ER -