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Randomized Controlled Trial
. 2024 Aug;113(8):1211-1218.
doi: 10.1007/s00392-023-02366-2. Epub 2024 Jan 3.

GLP-1 in patients with myocardial infarction complicated by cardiogenic shock-an IABP-SHOCK II-substudy

Michael Lehrke #  1 , Georg Fuernau #  2   3 , Christian Jung #  4 , Florian Kahles  5 , Julia Moellmann  5 , Ingo Eitel  6 , Nathalie Thelemann  6 , Steffen Desch  7 , Karl Werdan  8 , Uwe Zeymer  9 , Volker Adams  10 , Nikolaus Marx  5 , Holger Thiele  7
Affiliations
Randomized Controlled Trial

GLP-1 in patients with myocardial infarction complicated by cardiogenic shock-an IABP-SHOCK II-substudy

Michael Lehrke et al. Clin Res Cardiol. 2024 Aug.

Abstract

Background: Glucagon-like peptide-1 (GLP-1) is a gut-derived peptide secreted in response to nutritional and inflammatory stimuli. Elevated GLP-1 levels predict adverse outcome in patients with acute myocardial infarction or sepsis. GLP-1 holds cardioprotective effects and GLP-1 receptor agonists reduce cardiovascular events in high-risk patients with diabetes. In this study, we aimed to investigate the capacity of GLP-1 to predict outcome in patients with cardiogenic shock (CS) complicating myocardial infarction.

Methods: Circulating GLP-1 levels were serially assessed in 172 individuals during index PCI and day 2 in a prospectively planned biomarker substudy of the IABP-SHOCK II trial. All-cause mortality at short- (30 days), intermediate- (1 year), and long-term (6 years) follow-up was used for outcome assessment.

Results: Patients with fatal short-term outcome (n = 70) exhibited higher GLP-1 levels [86 (interquartile range 45-130) pM] at ICU admission in comparison to patients with 30-day survival [48 (interquartile range 33-78) pM; p < 0.001] (n = 102). Repeated measures ANOVA revealed a significant interaction of GLP-1 dynamics from baseline to day 2 between survivors and non-survivors (p = 0.04). GLP-1 levels above vs. below the median proved to be predictive for short- [hazard ratio (HR) 2.43; 95% confidence interval (CI) 1.50-3.94; p < 0.001], intermediate- [HR 2.46; 95% CI 1.62-3.76; p < 0.001] and long-term [HR 2.12; 95% CI 1.44-3.11; p < 0.001] outcome by multivariate Cox-regression analysis.

Conclusion: Elevated plasma levels of GLP-1 are an independent predictor for impaired prognosis in patients with myocardial infarction complicated by CS. The functional relevance of GLP-1 in this context is currently unknown and needs further investigations.

Trial registration: www.

Clinicaltrials: gov Identifier: NCT00491036.

Keywords: Cardiogenic shock; Critical illness; GLP-1; Inflammation; Mortality.

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References

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