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Prognostic value of mid-regional pro-adrenomedullin levels taken on admission and discharge in non-ST-elevation myocardial infarction: the LAMP (Leicester Acute Myocardial Infarction Peptide) II study.
| Content Provider | Semantic Scholar |
|---|---|
| Author | Dhillon, Onkar S. Khan, Sohail Qamar Narayan, Hafid K. Ng, Kelvin K. H. Struck, Joachim Quinn, Paulene A. Morgenthaler, Nils G. Squire, Iain B. Davies, Joan E. Bergmann, Andreas Ng, Leong Loke |
| Copyright Year | 2010 |
| Abstract | OBJECTIVES The purpose of this study was to assess the prognostic value of admission and discharge mid-regional pro-adrenomedullin (sAM) levels in non-ST-elevation myocardial infarction (MI) and identify values to aid clinical decision making. N-terminal pro-B-type natriuretic peptide and GRACE (Global Registry of Acute Coronary Events) score were used as comparators. BACKGROUND sAM is a stable precursor of adrenomedullin. METHODS We measured plasma sAM on admission and discharge in 745 non-ST-elevation MI patients (514 men, median age 70.0 +/- 12.7 years). The primary end point was a composite of death, heart failure, hospitalization, and recurrent acute MI over mean follow-up of 760 days (range 150 to 2,837 days), with each event assessed individually as secondary end points. RESULTS During follow-up, 120 (16.1%) patients died, and there were 65 (8.7%) hospitalizations for heart failure and 77 (10.3%) recurrent acute MIs. Both admission and discharge levels were increased (median 0.81 nmol/l [range 0.06 to 5.75 nmol/l] and 0.76 nmol/l [range 0.25 to 6.95 nmol/l], respectively) compared with established normal ranges. Multivariate adjusted Cox regression models revealed that both were associated with the primary end point (hazard ratio: 9.75 on admission and 7.54 on discharge; both p < 0.001). Admission sAM was particularly associated with early (<30 days) mortality (c-statistic = 0.90, p < 0.001), and when compared with N-terminal pro-B-type natriuretic peptide and GRACE score, it was the only independent predictor of this end point. Admission sAM >1.11 nmol/l identified those at highest risk of death (p < 0.001). Patients with above-median admission sAM may benefit from revascularization. CONCLUSIONS sAM level is prognostic for death or heart failure. Admission levels are a strong predictor of early mortality and, when >1.11 nmol/l, complements the GRACE score to improve risk stratification. |
| File Format | PDF HTM / HTML |
| DOI | 10.1016/j.jacc.2010.01.060 |
| Alternate Webpage(s) | http://www.onlinejacc.org/content/accj/56/2/125.full.pdf |
| PubMed reference number | 20620726 |
| Alternate Webpage(s) | https://doi.org/10.1016/j.jacc.2010.01.060 |
| Journal | Medline |
| Volume Number | 56 |
| Issue Number | 2 |
| Journal | Journal of the American College of Cardiology |
| Language | English |
| Access Restriction | Open |
| Content Type | Text |
| Resource Type | Article |
