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Title: Trimethylamine N-oxide and Risk Stratification after Acute Myocardial Infarction
Authors: Suzuki, Toru
Heaney, Liam M.
Jones, Donald J. L.
Ng, Leong L.
First Published: Nov-2016
Publisher: American Association for Clinical Chemistry
Citation: Clinical Chemistry, 2017, 63 (1), pp. 420-428
Abstract: Background: Risk stratification in acute myocardial infarction (MI) remains a clinical challenge. Trimethylamine N-oxide (TMAO), a gut-derived metabolite, was investigated for its ability to assist in risk stratification for acute MI hospitalizations. Methods: TMAO was analyzed in 1079 acute MI patients. Associations with adverse outcome of all-cause mortality or reinfarction (death/MI) for shorter (6-month) and longer (2-year) terms were assessed and compared to other cohort-specific biomarkers. Added value in risk stratification by combined use with the Global Registry of Acute Coronary Events (GRACE) score was also investigated. Results: TMAO independently predicted death/MI at 2 years [292 events, hazard ratio 1.21 (95% CI, 1.03–1.43), P = 0.023], but was not able to predict death/MI at 6 months (161 events, P = 0.119). For death/MI at 2 years, TMAO retained independent prediction of risk (P = 0.034) and improved stratification even after addition of multiple alternative and contemporary biomarkers previously shown to provide added prognostic value in this cohort. From these contemporary biomarkers, TMAO remained the only significant predictor of outcome. Further, TMAO improved risk stratification for death/MI at 6 months by down-classifying risk in patients with GRACE score >119 and plasma TMAO concentration ≤3.7 μ mol/L. Conclusions: TMAO levels showed association with poor prognosis (death/MI) at 2 years and superiority over contemporary biomarkers for patients hospitalized due to acute MI. Furthermore, when used with the GRACE score for calculating risk at 6 months, TMAO reidentified patients at lower risk after initial categorization into a higher-risk group and showed usefulness as a secondary risk stratification biomarker.
DOI Link: 10.1373/clinchem.2016.264853
ISSN: 1530-8561
Version: Post-print
Status: Peer-reviewed
Type: Journal Article
Rights: Copyright © 2016, American Association for Clinical Chemistry. Deposited with reference to the publisher’s open access archiving policy.
Description: The file associated with this record is under a 12 month embargo from publication in accordance with the publisher's self-archiving policy. The full text may be available through the publisher links provided above.
Appears in Collections:Published Articles, Dept. of Cancer Studies and Molecular Medicine

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