title: Midregional proadrenomedullin predicts mortality and major adverse cardiac events in patients presenting with chest pain: results from the CHOPIN trial.
abstract: OBJECTIVE
  Chest pain is a common complaint to emergency departments (EDs) and clinical risk factors are used to predict which patients are at risk for worse outcomes and mortality. The goal was to assess the novel biomarker midregional proadrenomedullin (MR-proADM) in prediction of mortality and major adverse cardiac events (MACE).
  
  
  METHODS
  This was a subanalysis of the CHOPIN study, a 16-center prospective trial that enrolled 2,071 patients presenting with chest pain within 6 hours of onset. The primary endpoint was 6-month all-cause mortality and the secondary endpoint was 30-day and 6-month MACE: ED visits or hospitalization for acute myocardial infarction, unstable angina, reinfarction, revascularization, and heart failure.
  
  
  RESULTS
  MR-proADM performed similarly to troponin (cTnI; c-statistic = 0.845 and 0.794, respectively) for mortality prediction in all subjects and had similar results in those with noncardiac diagnoses. MR-proADM concentrations were stratified by decile, and the cohort in the top decile had a 9.8% 6-month mortality risk versus 0.9% risk for those in the bottom nine deciles (p < 0.0001). MR-proADM, history of coronary artery disease (CAD), and hypertension were predictors of short-term MACE, while history of CAD, hypertension, cTnI, and MR-proADM were predictors of long-term MACE.
  
  
  CONCLUSIONS
  In patients with chest pain, MR-proADM predicts mortality and MACE in all-comers with chest pain and has similar prediction in those with a noncardiac diagnosis. This exploratory analysis is primarily hypotheses-generating and future prospective studies to identify its utility in risk stratification should be considered.
authors.affiliation: Department of Internal Medicine, University of California, San Diego, CA.
authors.forename: Kevin S
authors.initials: KS
authors.lastname: Shah
authors.affiliation: Department of Internal Medicine, University of California, San Diego, CA.
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Marston
authors.affiliation: Department of Cardiology, University Hospital Basel, Basel, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Mueller
authors.affiliation: Department of Emergency Medicine, University of California, San Diego, CA.
authors.forename: Sean-Xavier
authors.initials: SX
authors.lastname: Neath
authors.affiliation: Department of Cardiology, University of Maryland, Baltimore, MD.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Christenson
authors.affiliation: Department of Emergency Medicine, Henry Ford Health System, Detroit, MI.
authors.forename: James
authors.initials: J
authors.lastname: McCord
authors.affiliation: Department of Emergency Medicine, Henry Ford Health System, Detroit, MI.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Nowak
authors.affiliation: Department of Emergency Medicine, University of California, San Diego, CA.
authors.forename: Gary M
authors.initials: GM
authors.lastname: Vilke
authors.affiliation: Department of Cardiology, University of California, San Diego, CA.
authors.forename: Lori B
authors.initials: LB
authors.lastname: Daniels
authors.affiliation: Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA.
authors.forename: Judd E
authors.initials: JE
authors.lastname: Hollander
authors.affiliation: Department of Pathology, Hennepin County Medical Center and University of Minnesota, Minneapolis, MN.
authors.forename: Fred S
authors.initials: FS
authors.lastname: Apple
authors.affiliation: Department of Emergency Medicine, University of Kansas Hospital, Kansas City, KS.
authors.forename: Chad M
authors.initials: CM
authors.lastname: Cannon
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA.
authors.forename: John
authors.initials: J
authors.lastname: Nagurney
authors.affiliation: Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, CA.
authors.forename: Donald
authors.initials: D
authors.lastname: Schreiber
authors.affiliation: Department of Cardiology, University of Maryland, Baltimore, MD.
authors.forename: Christopher
authors.initials: C
authors.lastname: deFilippi
authors.affiliation: Department of Surgery, Virginia Commonwealth University, Richmond, VA.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Hogan
authors.affiliation: Department of Emergency Medicine, University of California, Davis Medical Center, Sacramento, CA.
authors.forename: Deborah B
authors.initials: DB
authors.lastname: Diercks
authors.affiliation: Department of Emergency Medicine, Duke University Medical Center, Durham, NC.
authors.forename: Alexander
authors.initials: A
authors.lastname: Limkakeng
authors.affiliation: Department of Cardiology, Veterans Administration Hospital, Minneapolis, MN.
authors.forename: Inder S
authors.initials: IS
authors.lastname: Anand
authors.affiliation: Department of Pathology, University of California, San Francisco, CA.
authors.forename: Alan H B
authors.initials: AH
authors.lastname: Wu
authors.affiliation: Department of Research, Veterans Affairs Medical Center, San Diego, CA.
authors.forename: Paul
authors.initials: P
authors.lastname: Clopton
authors.affiliation: Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN.
authors.forename: Allan S
authors.initials: AS
authors.lastname: Jaffe
authors.affiliation: Department of Emergency Medicine, Baylor College of Medicine, Houston, TX.
authors.forename: W Frank
authors.initials: WF
authors.lastname: Peacock
authors.affiliation: Department of Cardiology, University of California, San Diego, CA.|Department of Cardiology, Veterans Affairs Medical Center, San Diego, CA.
authors.forename: Alan S
authors.initials: AS
authors.lastname: Maisel
mesh_terms: D000208:Acute Disease; D053607:Adrenomedullin / Q000097:blood*; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002637:Chest Pain / Q000097:blood*; D004636:Emergency Service, Hospital; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000188:drug therapy / Q000401:mortality*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D017035:Pravastatin / Q000627:therapeutic use; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D011498:Protein Precursors; C088633:proadrenomedullin; D053607:Adrenomedullin; D017035:Pravastatin