Clinical Research
Myocardial Infarction
Prognostic Value of Midregional Pro-Adrenomedullin in Patients With Acute Myocardial Infarction: The LAMP (Leicester Acute Myocardial Infarction Peptide) Study

https://doi.org/10.1016/j.jacc.2006.12.038Get rights and content
Under an Elsevier user license
open archive

Objectives

This study sought to assess the prognostic impact of midregional pro-adrenomedullin (MR-proADM) after an acute myocardial infarction (AMI).

Background

Adrenomedullin (ADM) is elevated in heart failure (HF) and after AMI. Another part of its precursor, MR-proADM, is more stable in circulation and ex vivo. We investigated the cardiovascular prognostic value after AMI of MR-proADM and compared it with N-terminal pro-B-type natriuretic peptide (NTproBNP), a marker of death and HF.

Methods

We measured plasma MR-proADM and NTproBNP in 983 consecutive post-AMI patients (721 men, mean age 65.0 ± 12.2 years), 3 to 5 days after chest pain onset.

Results

There were 101 deaths and 49 readmissions with HF during follow-up (median 342, range 0 to 764 days). The MR-proADM was increased in patients with death or HF compared with survivors (median 1.19 nmol/l, range 0.09 to 5.39 nmol/l, vs. 0.71 nmol/l, range 0.25 to 6.66 nmol/l, p < 0.0001). Using a multivariate binary logistic model, log MR-proADM (odds ratio 4.22) and log NTproBNP (odds ratio 3.20) were significant independent predictors of death or HF (with creatinine, age, gender, and history of AMI). The areas under the receiver-operating characteristic curve for MR-proADM, NTproBNP, and the logistic model with both markers were 0.77, 0.79, and 0.84 respectively. Cox models for the predictors of death or HF showed the same variables (including log MR-proADM, hazard ratio 3.63; log NTproBNP, hazard ratio 2.67). The MR-proADM provided further risk stratification in those patients who had NTproBNP levels above the median (p < 0.0001). Findings were similar for death and HF as individual end points.

Conclusions

The ADM system is activated after AMI. The MR-proADM is a powerful predictor of adverse outcome, especially in those with an elevated NTproBNP. The MR-proADM may represent a clinically useful marker of prognosis after AMI.

Abbreviations and Acronyms

ADM
adrenomedullin
AMI
acute myocardial infarction
HF
heart failure
MR-proADM
midregional pro-adrenomedullin
NSTEMI
non–ST-segment elevation myocardial infarction
NTproBNP
N-terminal pro-B-type natriuretic peptide
STEMI
ST-segment elevation myocardial infarction

Cited by (0)

1

Dr. Khan is supported by a British Heart Foundation Junior Research Fellowship (FS/03/028/15486). BRAHMS AG is a midsized company based in Hennigsdorf, Germany; it commercializes immunoassays, and has developed the MR-proADM assay, for which it owns patent rights.

2

Dr. Bergmann holds ownership in BRAHMS AG and patent rights to the markers of the study, and is a member of the board of directors of BRAHMS AG.

3

Dr. Struck holds patent rights to the markers and is an employee of BRAHMS AG.

4

Dr. Morgenthaler is an employee of BRAHMS AG.