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

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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.


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.


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.


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 Identifier: NCT00491036.

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Cardiogenic shock


Enzyme-linked immunosorbent assay


Glucagon-like peptide-1


Intra-aortic balloon counterpulsation


Interquartile range


Multiple organ failure


Percutaneous coronary intervention


Systemic inflammatory response syndrome


Thrombolysis in myocardial infarction




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The IABP-SHOCK II trial was funded by grants from the German Research Foundation, the German Heart Research Foundation, the German Cardiac Society, Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte, and the Heart Center Leipzig at University of Leipzig, and by unrestricted grants from Maquet Cardiopulmonary and Teleflex Medical. This work was supported by the German Research Foundation (DFG) SFB/TRR219 (M-04 and M-05), Project-ID 403224013 and Interreg V-A grant EURlipids to ML as well as the CORONA Stiftung, Germany to NM.

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Correspondence to Michael Lehrke or Georg Fuernau.

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ML received grants and personal fees from Boehringer Ingelheim, grants and personal fees from MSD, grants and personal fees from Novo Nordisk, personal fees from Amgen, personal fees from Sanofi, personal fees from Astra Zeneca, personal fees from Bayer, personal fees from Lilly. FK has served as a speaker for Novo Nordisk, JM declares no conflict of interest, NM has served as speaker for Amgen, Bayer, Boehringer Ingelheim, Sanofi-Aventis, MSD, BMS, AstraZeneca, Lilly, NovoNordisk. All other authors declare no conflict of interests.

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Lehrke, M., Fuernau, G., Jung, C. et al. GLP-1 in patients with myocardial infarction complicated by cardiogenic shock—an IABP-SHOCK II-substudy. Clin Res Cardiol (2024).

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