Prognostic value of mid-regional pro-adrenomedullin in patients with acute myocardial infarction. Leicester Acute Myocardial Infarction Peptide (LAMP) study.

Abstract

Background: Adrenomedullin(ADM) is elevated in heart failure(HF) and after acute myocardial infarction(AMI). Another part of its precursor, mid-regional proADM(MR-proADM) is more stable in circulation and ex-vivo. We investigated the cardiovascular prognostic value post-AMI of MR-proADM and compared it to N-terminal 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±(SD)12.2 years), 3-5 days after chest pain onset. Results: There were 101 deaths and 49 readmissions with HF during follow up (median 342, range 0-764 days). MR-proADM was raised in patients with death or HF compared to survivors (median [range]nmol/L, 1.19[0.09-5.39] vs. 0.71[0.25-6.66]; p<0.0001). Using a multivariate binary logistic model, log MR-proADM (OR 4.22) and log NTproBNP (OR 3.20) were significant independent predictors of death or HF (with creatinine, age, gender and past history of AMI). The areas under the receiver-operating curve (AUC) 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 revealed the same variables (including log MR-proADM (HR 3.63), log NTproBNP (HR 2.67)). MR-proADM provided further risk stratification in those patients who had NTproBNP level above the median (p<0.0001). Findings were similar for death and HF as individual endpoints. Conclusions: The adrenomedullin system is activated post-AMI. MR-proADM is a powerful predictor of adverse outcome especially in those with an elevated NTproBNP. MR-proADM may represent a clinically useful marker of prognosis after AMI.