Abstract 3148: Elevated Plasma Level of Asymmetric Dimetylarginine (ADMA) is a Predictor of Total Mortality in Patients Presenting with Acute Myocardial Infarction
Asymmetric dimethylarginine is an endogenously formed inhibitor of nitric oxide synthases (NOS). Several studies in recent years demonstrated that elevation of ADMA is independently associated with adverse outcome in patients with cardiovascular disease. The role of ADMA in acute myocardial infarction has not been investigated so far. Therefore, the aim of the present prospective observational study was to investigate a possible relation between ADMA and outcome in patients with acute myocardial infarction.
Methods: In 295 consecutive patients (68% male, age 67±12 years) presenting with acute myocardial infarction (STEMI and NSTEMI) at the emergency department plasma ADMA concentration was determined by liquid chromatography tandem mass-spectrometry. Myocardial infarction was confirmed according to the guidelines of the ESC. Follow-up was 1 year for total mortality and cardiovascular events.
Results: During one year of follow-up 3 (3.1%), 7 (6.7%) and 16 (17.2%) of the patients with low, intermediate and high ADMA plasma concentrations died, trend p<0.001. The corresponding odds ratio for total mortality per 0.1 μmol increase in plasma ADMA concentration was 1.88 (95% CI:1.34 –2.64, p<0.001) and 1.78 (95%CI:1.16 –2.73, p=0.008) when adjusting for age, gender, family history of coronary artery disease, smoking, diabetes, hypertension, creatinine, STEMI vs. NSTEMI, maximal creatinine kinase level, and use of betablockers, statins or acetylsalicylic acid. The ROC (assessing specificity and sensitivity) of ADMA for future death was 0.725 p<0.001. For comparison, the respective ROC for age was 0.696, p<0.001, and the ROC for serum creatinine was 0.682, p=0.002.
Conclusion: The present study provides strong evidence that elevation of ADMA in patients presenting with acute myocardial infarction is an independent risk factor for a fatal outcome.