Journal Articles

Fasting Glucose, NT-proBNP, Treatment with Eptifibatide, and Outcomes in Non–ST-Segment Elevation Acute Coronary Syndromes: An Analysis from EARLY ACS

January 12, 2017

Serdar Farhan, Robert M. Clare, Rudolf Jarai, Robert P. Giugliano, Yuliya Lokhnygina, Robert A. Harrington, L. Kristin Newby, 1, Kurt Huber. Fasting Glucose, NT-proBNP, Treatment with Eptifibatide, and Outcomes in Non–ST-Segment Elevation Acute Coronary Syndromes: An Analysis from EARLY ACS. International Journal of Cardiology (2017).

Author Affiliations

a. 3rd Department of Internal Medicine, Cardiology, and Intensive Care Medicine, Wilhelminen Hospital, Vienna, Austria
b. Duke Clinical Research Institute, Durham, NC, USA
c. TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
d. Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA

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).

Conclusion

NT-proBNP and fasting glucose concentrations were associated with intermediate-term ischemic outcomes and may identify differential response to treatment with eptifibatide.

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