Abstract 17334: Midregional Pro-Adrenomedullin Predicts Major Coronary Events and Coronary Death in Patients Stable after an Acute Coronary Syndrome

Abstract

Introduction: Novel biomarkers such as midregional pro-adrenomedullin (MR-proADM) may contribute to long-term risk stratification in coronary heart disease (CHD). We examined whether MR-proADM plasma concentration and its change over one year predicted major CHD events (CHD death and non-fatal myocardial infarction) and CHD death in 7,863 patients, 3-36 months after an acute coronary syndrome (ACS) and with total cholesterol 155-271 mg/dl in the Long-Term Intervention with Pravastatin in Ischaemic Disease (LIPID) study. The LIPID study was funded by Bristol-Myers Squibb and the biomarker analysis by a project grant from the Australian NHMRC.

Methods: Cox regression analysis was used to examine the relationship between both baseline MR-proADM quartiles and change in MR-proADM over one year with subsequent events. Values were adjusted for baseline variables (statin treatment, prior stroke, diabetes, smoking, hypertension, total and HDL cholesterol, age, gender, type of prior ACS, timing of coronary revascularisation, systolic blood pressure, atrial fibrillation, eGFR, BMI, dyspnea and angina grades, white cell count, peripheral vascular disease, aspirin, fasting glucose, triglycerides, and Apo B/A1).

Results: Patients with increasing baseline MR-proADM quartiles showed a higher risk of CHD events and death (p<0.001). Hazard ratio (HR) for CHD death in the highest MR-proADM quartile (>0.578 nmol/l) compared to the lowest quartile (≤0.381 nmol/l) was 2.21 (1.67, 2.92). HR for CHD events was 1.52 (1.26, 1.84). An increase in MR-proADM concentration in the first year >0.057 nmol/l (highest quartile) corresponded with a higher risk of CHD events compared to those with a reduction ≥0.067 nmol/l (lowest quartile) (HR 1.34 (1.08, 1.66); p<0.01). Baseline MR-proADM concentrations increased discrimination for the prediction of CHD events (NRI 2.79 %, p=0.06, IDI 0.0016; p=0.002).

Conclusions: Increased MR-proADM in patients stable after an ACS predicts recurrent CHD events and CHD death. Change in MR-proADM over one year is also associated with subsequent events. MR-proADM and its change may identify some patients who need intensified surveillance and therapy.