title: Comparison of long-term prognostic value of N-terminal-proBNP and midregional-pro-adrenomedullin in patients with acute myocardial infarction.
abstract: BACKGROUND
  N-terminal-proBNP (NT-proBNP) and Midregional-pro-Adrenomedullin (MR-proADM) predict mortality of patients with acute myocardial infarction (AMI). Comparison of the prognostic values of NT-proBNP and MR-proADM to predict long-term adverse clinical events (AE) after AMI has not been evaluated yet.
  
  
  METHODS
  30 patients with AMI were enrolled into this prospective study. Measurements of NT-proBNP and MR-proADM were performed at initial presentation, two or three days and four months after AMI. Long-term AE defined as recurrent AMI, need for repeated percutaneous transluminal angioplasty or coronary bypass graft surgery, congestive heart failure, cardiopulmonary resuscitation, cardiogenic shock, syncope, and death were documented during a follow-up period of ten months.
  
  
  RESULTS
  At initial presentation, NT-proBNP values were significantly higher in patients with AE compared to patients without AE (p < 0.05). The area under the ROC curve (AUC) indicated good predictive performance of NT-proBNP (AUC 0.78, 95% CI 0.59-0.91, p = 0.003) and MR-proADM (AUC 0.71, 95% CI 0.51-0.86, p = 0.046) regarding AE. Comparing both AUC revealed no differences between NT-proBNP and MR-proADM as predictors of AE (p = 0.59). Patients with NT-proBNP levels > or = 370 pg/mL were more likely to suffer from AE than patients with lower levels (relative risk 6.7, 95% CI 1.0-46, p = 0.018). With this cutoff, NT-proBNP could exclude AE with a negative predictive value of 92% being similar to MR-proADM (negative predictive value 76%, relative risk 2.8, 95% CI 1.2-6.9, p = 0.042).
  
  
  CONCLUSIONS
  Early measurements of NT-proBNP or MR-proADM during the acute phase of AMI may allow the risk of a long-term AE to be excluded, based on the comparable test characteristics,.
authors.affiliation: First Department of Medicine (Cardiology), University Medical Centre Mannheim, Mannheim, Germany. thomas.walter.med@umm.de
authors.forename: Thomas
authors.initials: T
authors.lastname: Walter
authors.forename: Martina
authors.initials: M
authors.lastname: Brueckmann
authors.forename: Siegfried
authors.initials: S
authors.lastname: Lang
authors.forename: Tamara
authors.initials: T
authors.lastname: Sauer
authors.forename: Esther
authors.initials: E
authors.lastname: Fiedler
authors.forename: Jana
authors.initials: J
authors.lastname: Papassotiriou
authors.forename: Michael
authors.initials: M
authors.lastname: Behnes
authors.forename: Elif
authors.initials: E
authors.lastname: Elmas
authors.forename: Martin
authors.initials: M
authors.lastname: Borggrefe
authors.forename: Thomas
authors.initials: T
authors.lastname: Bertsch
mesh_terms: D053607:Adrenomedullin / Q000097:blood*; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood*; D001774:Blood Chemical Analysis; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D053607:Adrenomedullin