Plasma BNP Levels and Diuretics Use as Predictors of Cardiovascular Events in Patients with Myocardial Infarction and Impaired Glucose Tolerance
Plasma BNP Levels and Diuretics Use as Predictors of Cardiovascular Events in Patients with Myocardial Infarction and Impaired Glucose Tolerance
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DOI：
10.1007/s10557-019-06922-9
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发表时间：
2020-02-20
影响因子：
3.4
通讯作者：
Kitakaze, Masafumi
中科院分区：
文献类型：
--
作者：
Shindo, Kazuhiro;Fukuda, Hiroki;Kitakaze, Masafumi
目的虽然糖耐量受损（IGT）会促进心血管事件的发生，但我们的α-葡萄糖苷酶抑制剂阻断心肌梗死和糖耐量受损（ABC）患者的心脏事件研究表明，α-葡萄糖苷酶抑制剂不能预防心肌梗死和IGT患者的心血管事件。本研究的目的是确定MI和IGT患者心血管事件的潜在临床因素。方法采用基于人工智能（AI）的数据挖掘方法--有限多元检验法，对385,391个少于4个临床参数的组合进行分析。结果在853例患者的385，391种组合中，我们确定了380种组合，可预测（1）全因住院，（2）因心力衰竭（HF）恶化住院，（3）因非致命性MI住院，（4）因稳定型心绞痛接受经皮冠状动脉介入治疗（PCI）和冠状动脉旁路移植术（CABG）住院。其中，血浆BNP水平>= 200 pg/dl或利尿剂使用仅预测（1）全因住院，（2）因HF恶化住院，（3）因非致命性MI住院，血浆BNP水平>= 200 pg/dl是PCI和CABG住院的唯一预测因素。重要的是，每个发现都通过独立绘制的Kaplan-Meier曲线进行了验证，揭示了血浆BNP水平在冠状动脉狭窄进展中的意外作用，确定为PCI和CABG治疗稳定型心绞痛的必要性。结论在MI和IGT患者中，高血浆BNP水平可预测冠状动脉狭窄、MI复发和HF恶化的发生，而利尿剂的使用不能预测冠状动脉狭窄的进展，但可预测非致命性MI和HF恶化。
Purpose Although impaired glucose tolerance (IGT) promotes cardiovascular events, our Alpha-glucosidase-inhibitor Blocks Cardiac Events in Patients with Myocardial Infarction and Impaired Glucose Tolerance (ABC) study showed that alpha-glucosidase inhibitors do not prevent cardiovascular events in patients with myocardial infarction (MI) and IGT. The aim of the present study was to identify potential clinical factors for cardiovascular events in patients with MI and IGT. Methods Using the limitless-arity multiple testing procedure, an artificial intelligence (AI)-based data mining method, we analyzed 385,391 combinations of fewer than four clinical parameters. Results We identified 380 combinations predicting the occurrence of (1) all-cause hospitalization, (2) hospitalization due to worsening of heart failure (HF), (3) hospitalization due to non-fatal MI, and (4) hospitalization due to percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) for stable angina among 385,391 combinations in 853 patients. Among these, either plasma BNP levels >= 200 pg/dl or diuretic use exclusively predicted (1) all-cause hospitalization, (2) hospitalization due to worsening of HF, and (3) hospitalization due to a non-fatal MI, with plasma BNP levels >= 200 pg/dl being the sole predictor of hospitalization due to PCI and CABG. Importantly, each finding was verified by independently drawn Kaplan-Meier curves, revealing the unexpected role of plasma BNP levels in the progression of coronary stenosis determined as the necessity of PCI and CABG for stable angina. Conclusions In patients with MI and IGT, high plasma BNP levels predicted the occurrence of coronary stenosis, recurrent MI, and worsening of HF, whereas diuretic use did not predict the progression of coronary stenosis but non-fatal MI and worsening of HF.