Abstract 3077: Mid-Regional Pro-Adrenomedullin Predicts Risk of Death or Heart Failure in Patients with Acute Myocardial Infarction - the Leicester Acute Myocardial Infarction Peptide (LAMP) Study
Background: Adrenomedullin (ADM), a vasodilator peptide, which is elevated in heart failure, predicts death post AMI. Clinical use has been limited. Its precursor mid-regional proADM (MR-proADM) is more stable in circulation and ex vivo. We sought to investigate the cardiovascular prognostic value of MR-proADM and compared it to N terminal B type natriuretic peptide (NT-BNP), a marker of death and heart failure
Methods: We studied 983 consecutive post AMI patients (721 men, mean age 65.0 ± 12.2 years). Plasma measurements were made 3–5 days after chest pain onset. The plasma concentration of NT-BNP was determined using an in-house non-competitive chemiluminescent immunoassay and MR-proADM was detected using a novel commercial assay (BRAHMS AG). Patients were followed-up for the combined endpoint of death or heart failure.
Results: Over the median follow up period of 342 days (range 0–764) there were 101 deaths and 49 readmissions with HF. MR-proADM was raised in patients with death or heart failure compared to survivors (median [range] nmol/L, 1.17[0.09–5.39] vs. 0.7[0.25– 6.66], p<0.0001). Using a multivariate binary logistic model, log MR-proADM (OR 4.22), log NT-BNP (OR 3.19), log creatinine (OR 8.24), age (OR 1.04), male gender (OR 0.65) and past history of MI (OR 2.51), were significant independent predictors of death or heart failure. The receiver-operating curve for MR-proADM yielded an area under the curve (AUC) of 0.76(95% CI: 0.72– 0.81, p<0.001) for NT-BNP the AUC was 0.79 (95% CI: 0.75– 0.83, p<0.001); the logistic model combining the 2 markers yielded an AUC of 0.84 (95% CI: 0.81– 0.88, p<0.001). The Cox proportional hazards model for predicting death or heart failure revealed the same variables (including log MR-proADM (HR 3.62), log NT-BNP (HR 2.66)). Kaplan-Meier analysis confirmed significantly better clinical outcome in patients with MR-proADM below the median in patients stratified by NT-BNP (below median, p<0.02, above median p<0.0001). Similar findings were obtained with death and heart failure as individual endpoints.
Conclusion: After an AMI, combined levels of MR-proADM and NT-BNP are more informative at predicting death or heart failure than either marker alone. MR-proADM is especially useful in patients with NT-BNP above median.