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.
OBJECTIVE
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.
Dhillon
Onkar S
OS
Department of Cardiovascular Sciences, University of Leicester, Leicester Royal Infirmary, Leicester, United Kingdom. dhillonos@hotmail.com
Khan
Sohail Q
SQ
Narayan
Hafid K
HK
Ng
Kelvin H
KH
Struck
Joachim
J
Quinn
Paulene A
PA
Morgenthaler
Nils G
NG
Squire
Iain B
IB
Davies
Joan E
JE
Bergmann
Andreas
A
Ng
Leong L
LL
D053607:Adrenomedullin / Q000097:blood*; D000368:Aged; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000401:mortality; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000097:blood* / Q000503:physiopathology; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010343:Patient Admission; D010351:Patient Discharge; D010446:Peptide Fragments / Q000097:blood; D011379:Prognosis; D011498:Protein Precursors / Q000097:blood*
D010446:Peptide Fragments; D011498:Protein Precursors; C109794:pro-brain natriuretic peptide (1-76); C088633:proadrenomedullin; D020097:Natriuretic Peptide, Brain; D053607:Adrenomedullin