title: Mid-regional pro-adrenomedullin in the early evaluation of acute chest pain patients.
abstract: BACKGROUND
  The purpose of this study was to investigate the utility of mid-regional pro-adrenomedullin (MR-proADM) in the early diagnosis and risk stratification of patients with acute chest pain in comparison with established and novel biomarkers and risk scores.
  
  
  METHODS
  In this prospective, observational, international, multi-center trial (APACE), MR-proADM was determined in 1179 unselected patients with acute chest pain. Patients were followed for 24 months.
  
  
  RESULTS
  MR-proADM concentrations at presentation were higher in patients with AMI (median: 0.78 nmol/l, IQR 0.60-1.13) than in patients with other diagnoses (0.64 nmol/l, IQR 0.49-0.86 nmol/l; p<0.001). The diagnostic accuracy of MR-proADM for AMI as quantified by the area under the receiver operating characteristic curve (AUC) was 0.66. Adding MR-proADM to hs-cTnT could not improve its diagnostic accuracy for AMI (p=0.431). Seventy-six percent of all deaths occurred in the fourth quartile of MR-proADM (>0.90 nmol/l). Adding MR-proADM to the TIMI-score (AUC 0.87) predicted 1-year mortality more accurately than the TIMI-score alone (AUC 0.82; p<0.001). Net reclassification improvement (TIMI vs. additionally MR-proADM) amounted to 0.137 (p=0.012). MR-proADM had higher prognostic accuracy as compared to hs-cTnT in patients with AMI (p=0.015) and in those without AMI (p=0.003). MR-proADM at presentation was tantamount to GRACE score and BNP as to its prognostic accuracy for mortality. The AUC for the prediction of cardiovascular events amounted to 0.63.
  
  
  CONCLUSIONS
  While MR-proADM does not have clinical utility in the early diagnosis of AMI or predicting cardiovascular events in patients with acute chest pain, it may provide prognostic value for all-cause mortality.
authors.affiliation: Department of Internal Medicine, Division of Cardiology, University Hospital, Basel, Switzerland.
authors.forename: Philip
authors.initials: P
authors.lastname: Haaf
authors.forename: Raphael
authors.initials: R
authors.lastname: Twerenbold
authors.forename: Tobias
authors.initials: T
authors.lastname: Reichlin
authors.forename: Jonathan
authors.initials: J
authors.lastname: Faoro
authors.forename: Miriam
authors.initials: M
authors.lastname: Reiter
authors.forename: Christophe
authors.initials: C
authors.lastname: Meune
authors.forename: Stephan
authors.initials: S
authors.lastname: Steuer
authors.forename: Stefano
authors.initials: S
authors.lastname: Bassetti
authors.forename: Ronny
authors.initials: R
authors.lastname: Ziller
authors.forename: Cathrin
authors.initials: C
authors.lastname: Balmelli
authors.forename: Isabel
authors.initials: I
authors.lastname: Campodarve
authors.forename: Christa
authors.initials: C
authors.lastname: Zellweger
authors.forename: Ashley
authors.initials: A
authors.lastname: Kilchenmann
authors.forename: Affan
authors.initials: A
authors.lastname: Irfan
authors.forename: Jana
authors.initials: J
authors.lastname: Papassotiriou
authors.forename: Beatrice
authors.initials: B
authors.lastname: Drexler
authors.forename: Christian
authors.initials: C
authors.lastname: Mueller
mesh_terms: D000208:Acute Disease; D053607:Adrenomedullin / Q000097:blood*; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002637:Chest Pain / Q000097:blood* / Q000175:diagnosis* / Q000401:mortality; D015331:Cohort Studies; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D038622:Internationality; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*
chemical_list: D015415:Biomarkers; D011498:Protein Precursors; C088633:proadrenomedullin; D053607:Adrenomedullin