Abstract 575: Midregional Pro-Adrenomedullin for Risk Stratification in Coronary Artery Disease - Results from the AtheroGene Study
Objective: Midregional pro-adrenomedullin (MR-proADM) is a novel identified stable peptide that is suspected to be a predictor of prognosis in cardiovascular disease. We aimed at evaluating the prognostic impact of MR-proADM in patients with documented coronary artery disease. Methods: Baseline MR-proADM concentrations were measured in 2240 individuals from the prospective AtheroGene study. The prognostic impact on future cardiovascular events was evaluated during a follow-up period of 3.6 ± 1.6 years (max. 6.9 years).
Results: The sample comprised 1355 individuals with stable angina pectoris (SAP) and 885 with an acute coronary syndrome (ACS). A cardiovascular event occurred in 192 persons. Individuals presenting with SAP had lower MR-proADM concentrations than those with ACS (0.53 nmol/l vs. 0.55 nmol/l, P=0.006). MR-proADM showed a moderate association to age, NT-proBNP, glomerular filtration rate, CRP, hypertension, diabetes mellitus and prevalent multi-vessel disease (all P<0.0005). Individuals suffering from a cardiovascular event had higher ADM concentrations at baseline in both groups (SAP 0.63 nmol/l vs. 0.53 nmol/l and ACS 0.65 nmol/l vs. 0.55 nmol/l, both P<0.0005). Cox regression analysis incorporating variables of cardiovascular risk revealed a hazard ratio of 7.0 (95%CI: 3.9–12.4) for an increment of MR-proADM by one standard deviation (P<0.0005). In the C-statistic by analysis of receiver operating characteristic curves, inclusion of MR-proADM to the basic model increased the area under the curve as much as NT-proBNP did.
Conclusion: MR-proADM is a powerful predictor for future cardiovascular events in the setting of coronary artery disease that adds prognostic information beyond that obtained from classical risk models including NT-proBNP.