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MR-proADM as a Prognostic Marker in Patients With ST-Segment-Elevation Myocardial Infarction-DANAMI-3 (a Danish Study of Optimal Acute Treatment of Patients With STEMI) Substudy.
- Source :
-
Journal of the American Heart Association [J Am Heart Assoc] 2018 May 18; Vol. 7 (11). Date of Electronic Publication: 2018 May 18. - Publication Year :
- 2018
-
Abstract
- Background: Midregional proadrenomedullin (MR-proADM) has demonstrated prognostic potential after myocardial infarction (MI). Yet, the prognostic value of MR-proADM at admission has not been examined in patients with ST-segment-elevation MI (STEMI).<br />Methods and Results: The aim of this substudy, DANAMI-3 (The Danish Study of Optimal Acute Treatment of Patients with ST-segment-elevation myocardial infarction), was to examine the associations of admission concentrations of MR-proADM with short- and long-term mortality and hospital admission for heart failure in patients with ST-segment-elevation myocardial infarction. Outcomes were assessed using Cox proportional hazard models and area under the curve using receiver operating characteristics. In total, 1122 patients were included. The median concentration of MR-proADM was 0.64 nmol/L (25th-75th percentiles, 0.53-0.79). Within 30 days 23 patients (2.0%) died and during a 3-year follow-up 80 (7.1%) died and 38 (3.4%) were admitted for heart failure. A doubling of MR-proADM was, in adjusted models, associated with an increased risk of 30-day mortality (hazard ratio, 2.67; 95% confidence interval, 1.01-7.11; P =0.049), long-term mortality (hazard ratio, 3.23; 95% confidence interval, 1.97-5.29; P <0.0001), and heart failure (hazard ratio, 2.71; 95% confidence interval, 1.32-5.58; P =0.007). For 30-day and 3-year mortality, the area under the curve for MR-proADM was 0.77 and 0.78, respectively. For 3-year mortality, area under the curve (0.84) of the adjusted model marginally changed (0.85; P =0.02) after addition of MR-proADM.<br />Conclusions: Elevation of admission MR-proADM was associated with long-term mortality and heart failure, whereas the association with short-term mortality was borderline significant. MR-proADM may be a marker of prognosis after ST-segment-elevation myocardial infarction but does not seem to add substantial prognostic information to established clinical models.<br />Clinical Trial Registration: URL: http:/www.ClinicalTrials.gov/. Unique identifiers: NCT01435408 and NCT01960933.<br /> (© 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.)
- Subjects :
- Aged
Aged, 80 and over
Biomarkers blood
Denmark
Female
Heart Failure blood
Heart Failure etiology
Heart Failure mortality
Humans
Male
Middle Aged
Predictive Value of Tests
Risk Assessment
Risk Factors
ST Elevation Myocardial Infarction diagnosis
ST Elevation Myocardial Infarction mortality
Time Factors
Treatment Outcome
Up-Regulation
Adrenomedullin blood
Peptide Fragments blood
Percutaneous Coronary Intervention adverse effects
Percutaneous Coronary Intervention mortality
Protein Precursors blood
ST Elevation Myocardial Infarction blood
ST Elevation Myocardial Infarction therapy
Subjects
Details
- Language :
- English
- ISSN :
- 2047-9980
- Volume :
- 7
- Issue :
- 11
- Database :
- MEDLINE
- Journal :
- Journal of the American Heart Association
- Publication Type :
- Academic Journal
- Accession number :
- 29776961
- Full Text :
- https://doi.org/10.1161/JAHA.117.008123