MR-proANP and MR-proADM for risk stratification of patients with acute chest pain

作者：Tzikas Stergios; Keller Till^*; Ojeda Francisco M; Zeller Tanja; Wild Philipp S; Lubos Edith; Kunde Jan; Baldus Stephan; Bickel Christoph; Lackner Karl J; Muenzel Thomas F; Blankenberg Stefan

来源：Heart, 2013, 99(6): 388-395.

DOI：10.1136/heartjnl-2012-302956

Objective To evaluate mid-regional pro-adrenomedullin (MR-proADM) and mid-regional pro-atrial natriuretic peptide (MR-proANP) as prognostic biomarkers in a representative %26apos;real world%26apos; cohort of patients with suspected acute coronary syndrome (ACS). %26lt;br%26gt;Design Prospective observational multicentre cohort study. %26lt;br%26gt;Setting Chest pain units of three major hospitals in Germany from 2007 to 2008. %26lt;br%26gt;Patients Patients presenting with signs and symptoms suggestive of an ACS. %26lt;br%26gt;Main outcome measures Primary end point was death or non-fatal myocardial infarction (MI), and secondary end point was death, non-fatal MI, stroke, need for coronary revascularisation, and hospital admission for cardiovascular cause or acute heart failure within 6 months after enrolment. %26lt;br%26gt;Results 1386 patients (male/female=920/466) were enrolled. Follow-up information was available for 97.8% of patients (median follow-up time 183 days). Forty-three patients reached the primary end point, and 132 the secondary end point. Patients who reached a primary end point had significantly higher MR-proANP (271 vs 101 pmol/l, p%26lt;0.001) and MR-proADM (0.86 vs 0.59 nmol/l, p%26lt;0.001) concentrations than those who did not. Cox regression analysis revealed a 2.55-fold risk of death or non fatal MI (95% CI 1.48 to 2.46, p%26lt;0.001) for an increment of the log-transformed MR-proANP concentration by 1 SD after adjustment for cardiovascular risk factors, and a 1.91-fold risk (95% CI 1.48 to 2.46, p%26lt;0.001) for MR-proADM. Both peptides could result in significant reclassification of patients when added to the Global Registry of Acute Coronary Events risk score, with an overall net reclassification improvement of 41.2% for MR-proADM and 35.7% for MR-proANP. %26lt;br%26gt;Conclusions MR-proADM and MR-proANP are predictors of future cardiovascular events in patients presenting with acute chest pain and might facilitate the choice of treatment in those patients complementary to established risk scores.

• 出版日期2013-3