Can BNP levels and Killip grading assess the severity of injury to myocardium after acute myocardial infarction in Type II Diabetics?

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Type II Diabetes with acute myocardial infarction (n=196). Intervention: Suboptimal glycemic control (HbA1c > 7%) vs. Optimal glycemic control (HbA1c ≤ 7%). Primary outcome: Severe heart stress (plasma BNP level > 900 pg/ml) (p=<0.001).

Q: What does this research mean for the field?

Sub-optimal glycemic control in type II diabetic patients post-acute myocardial infarction is associated with a significantly higher prevalence of severe myocardial injury marked by BNP levels >900 pg/ml compared to optimal glycemic control, while Killip scale grading does not differ between glycemic groups. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Soheb Rehman; Mehwish Durrani; Ashfaq Ahmad Shah Bukhari; Kalsoom Tariq; Aziz Ur Rehman; Muhammad Shafiq

doi:10.52442/jrmi.v4i3.131

January 18, 2021Journal of Rehman Medical InstituteOpen Access

Can BNP levels and Killip grading assess the severity of injury to myocardium after acute myocardial infarction in Type II Diabetics?

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Why the study?

The validity of Killip Scale and plasma BNP levels for post-MI risk assessment in type II diabetic patients was uncertain.

Does optimal glycemic control correlate with lower severity of myocardial injury (assessed by BNP and Killip grading) in type II diabetic patients after acute myocardial infarction?

Key Points

To compare the validity of plasma B-type natriuretic peptide (BNP) levels and clinical Killip scale grading for post-infarction risk assessment in type II diabetic patients following acute myocardial infarction.
Conducted a descriptive cross-sectional study of N=196 type II diabetic patients presenting with a first episode of acute myocardial infarction at Rehman Medical Institute and Lady Reading Hospital in Peshawar between November 1, 2014, and June 30, 2015.
Categorized patients into an optimal glycemic control group (HbA1c ≤ 7%, n=35) and a suboptimal glycemic control group (HbA1c > 7%, n=161).
Evaluated myocardial injury and heart failure status using plasma BNP assays, Killip scale classification (Classes I to IV), and echocardiography.
Severe cardiac stress marked by BNP levels > 900 pg/ml occurred in 5.71% of the optimal control group versus 17.39% of the suboptimal control group (p<0.001), with a weak but significant positive correlation between HbA1c and BNP in the suboptimal cohort (r=0.2, p=0.01).
No significant difference was detected between glycemic control groups across Killip classes (Class I: 57.1% vs 57.1%, p=1.00; Class II: 22.9% vs 13.7%, p=0.28; Class III: 11.4% vs 19.9%, p=0.34; Class IV: 8.5% vs 9.3%, p=0.90; overall p>0.05).
Heart failure rates determined clinically by Killip grading were identical between optimal and suboptimal glycemic groups at 42.9% each.

Study Design

Type

Cross-Sectional (n=196)

Multicenter

Yes

Structured PICO

Does optimal glycemic control correlate with lower severity of myocardial injury (assessed by BNP and Killip grading) in type II diabetic patients after acute myocardial infarction?

P

Population

196 type II diabetic patients admitted after their first episode of acute myocardial infarction who received thrombolytic treatment within 12 hours of chest pain onset.

E

Exposure

Suboptimal glycemic control (HbA1c > 7%)

C

Comparator

Optimal glycemic control (HbA1c ≤ 7%)

O

Outcome

Severity of myocardial injury assessed by plasma BNP levels and Killip scale gradingsurrogate

Main Result

Absolute Event Rate: 17.39% vs 5.71%

p-value: p=<0.001

In type II diabetic patients with acute myocardial infarction, poor glycemic control is associated with higher plasma BNP levels indicating greater myocardial stress, although clinical Killip grading does not significantly differ.

Limitations

Non-probability convenience sampling
Subjectivity in clinical assessment of Killip Scale grading by different examiners
Timing of blood sampling for BNP measurement may be affected by its biphasic peak after AMI
Timing of blood sample taken during the acute phase of AMI for plasma BNP measurement, as BNP peaks twice, which may yield data where interpretation becomes difficult and inconclusive.

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Implication

Suboptimal control linked to higher BNP post-MI in diabetes; leaves open whether glycemic optimization reduces myocardial stress.

Abstract

Introduction: Post myocardial infarction risk assessment and stratification is done clinically using Killip Scale as well as biochemically by measuring plasma B-type Natriuretic Peptide (BNP) levels.Objective: To compare the validity of the two diagnostic modalities in type II diabetic patients who had recently suffered from acute myocardial infarction (AMI).Materials & Methods: This descriptive cross-sectional study was conducted on 196 type II diabetic patients admitted after first episode of AMI in the Department of Cardiology at Rehman Medical Institute (RMI) and Lady Reading Hospital (LRH) Peshawar from 1st November 2014 to 30th June 2015 through convenience sampling. The subjects were divided into two groups; optimal control group and sub-optimal control group on the basis of HbA1c levels. Blood samples were taken and analyzed for HbA1c and BNP levels. Killip scale grading and echocardiography were recorded. Post MI risk assessment was done by Killip scale as well as by plasma BNP levels. SPSS version 16.0 was used to analyze the data for descriptive and comparative statistics, keeping p≤0.05 significant.Results: Significant difference (p<0.001) in the BNP levels were observed between optimal and suboptimal control groups with severe heart disease who had plasma BNP level of more than 900 pg/ml (5.71% vs 17.39%). No association was found between glycemic control and Killip scale grading (p>0.05). There was also no significant difference in classes (II, III and IV based on Killip scale grading) between two groups.Conclusion: High BNP levels were recorded in post MI patients in both the groups whereas the Killip Scale grades did not differ significantly in BNP levels in post MI patients.

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Cite This Study

Rehman et al. (2021) conducted a cross-sectional in Type II Diabetes with acute myocardial infarction (n=196). Suboptimal glycemic control (HbA1c > 7%) vs. Optimal glycemic control (HbA1c ≤ 7%) was evaluated on Severe heart stress (plasma BNP level > 900 pg/ml) (p=<0.001).

synapsesocial.com/papers/6ac1aba6cc6172083c928ab8 https://doi.org/10.52442/jrmi.v4i3.131

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Can BNP levels and Killip grading assess the severity of injury to myocardium after acute myocardial infarction in Type II Diabetics?

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Can BNP levels and Killip grading assess the severity of injury to myocardium after acute myocardial infarction in Type II Diabetics?

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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