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Title: Pro-substance p for evaluation of risk in acute myocardial infarction.
Authors: Ng, Leong L.
Sandhu, Jatinderpal K.
Narayan, Hafid
Quinn, Paulene A.
Squire, Iain B.
Davies, Joan E.
Struck, J.
Bergmann, A.
Maisel, A.
Jones, Donald J.L.
First Published: 21-Oct-2014
Publisher: Elsevier for the American College of Cardiology
Citation: Journal of the American College of Cardiology, 2014, 64 (16), pp. 1698-1707
Abstract: Background Pro-substance P (ProSP) is a stable surrogate marker for labile substance P, which has pro-inflammatory effects, increases platelet aggregation and clot strength, and reduces fibrinolysis. Objectives This study assessed whether ProSP was associated with poor prognosis after acute myocardial infarction (AMI) to identify novel pathophysiological mechanisms. Methods ProSP was measured in 1,148 AMI patients (825 men, mean age 66.2 ± 12.8 years). Endpoints were major adverse cardiac events (composite of death, reinfarction, and heart failure [HF] hospitalization), death/reinfarction, and death/HF. GRACE (Global Registry of Acute Coronary Events) scores were compared with ProSP for death and/or reinfarction at 6 months. Results During 2-year follow-up, there were 140 deaths, 112 HF hospitalizations, and 149 re-AMI. ProSP levels were highest on the first 2 days after admission and related to estimated glomerular filtration rate, age, history of diabetes, ischemic heart disease or hypertension, Killip class, left ventricular wall motion index, and sex. Multivariate Cox regression models showed ProSP level was a predictor of major adverse events (hazard ratio [HR]: 1.30; 95% confidence interval [CI]: 1.10 to 1.54; p < 0.002), death and/or AMI (HR: 1.42; 95% CI: 1.20 to 1.68; p < 0.0005), death and/or HF (HR: 1.38; 95% CI: 1.14 to 1.67; p < 0.001). ProSP levels with GRACE scores were independent predictors of 6-month death and/or reinfarction (p < 0.0005 for both). ProSP-adjusted GRACE scores reclassified patients significantly (overall category-free net reclassification improvement of 31.6 (95% CI: 14.3 to 49.0; p < 0.0005) mainly by down-classifying those without endpoints. Conclusions ProSP levels post-AMI are prognostic for death, recurrent AMI, or HF, and they improve risk prediction of GRACE scores, predominantly by down-classifying risk in those without events.
DOI Link: 10.1016/j.jacc.2014.05.074
ISSN: 0735-1097
eISSN: 1558-3597
Version: Post-print
Status: Peer-reviewed
Type: Journal Article
Rights: Archived with reference to SHERPA/RoMEO and publisher website. NOTICE: this is the author’s version of a work that was accepted for publication in Journal of the American College of Cardiology . Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Journal of the American College of Cardiology Volume 64, Issue 16, (21 October 2014) DOI 10.1016/j.jacc.2014.05.074
Appears in Collections:Published Articles, Dept. of Cardiovascular Sciences

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