Prognostic value of mid-regional pro-adrenomedullin in patients with acute myocardial infarction. Leicester Acute Myocardial Infarction Peptide (LAMP) study.

Background: Adrenomedullin(ADM) is elevated in heart failure(HF) and after acute myocardial infarction(AMI). Another part of its precursor, mid-regional proADM(MR-proADM) is more stable in circulation and ex-vivo. We investigated the cardiovascular prognostic value post-AMI of MR-proADM and compared it to N-terminal B-type natriuretic peptide (NTproBNP), a marker of death and HF. Methods: We measured plasma MR-proADM and NTproBNP in 983 consecutive post-AMI patients (721 men, mean age 65.0±(SD)12.2 years), 3-5 days after chest pain onset. Results: There were 101 deaths and 49 readmissions with HF during follow up (median 342, range 0-764 days). MR-proADM was raised in patients with death or HF compared to survivors (median [range]nmol/L, 1.19[0.09-5.39] vs. 0.71[0.25-6.66]; p<0.0001). Using a multivariate binary logistic model, log MR-proADM (OR 4.22) and log NTproBNP (OR 3.20) were significant independent predictors of death or HF (with creatinine, age, gender and past history of AMI). The areas under the receiver-operating curve (AUC) for MR-proADM, NTproBNP and the logistic model with both markers were 0.77, 0.79 and 0.84 respectively. Cox models for the predictors of death or HF revealed the same variables (including log MR-proADM (HR 3.63), log NTproBNP (HR 2.67)). MR-proADM provided further risk stratification in those patients who had NTproBNP level above the median (p<0.0001). Findings were similar for death and HF as individual endpoints. Conclusions: The adrenomedullin system is activated post-AMI. MR-proADM is a powerful predictor of adverse outcome especially in those with an elevated NTproBNP. MR-proADM may represent a clinically useful marker of prognosis after AMI

C-terminal pro-endothelin-1 offers additional prognostic information in patients after acute myocardial infarction. Leicester Acute Myocardial Infarction Peptide (LAMP) study.

Background: Endothelin-1 is elevated in heart failure (HF) and after acute myocardial infarction (AMI) and gives prognostic information on mortality. Another part of its precursor, C-terminal Pro-Endothelin-1 (CT-proET-1), is more stable in circulation and ex-vivo. We investigated the cardiovascular prognostic value post-AMI of CT-proET-1 and compared it to N-terminal B-type natriuretic peptide (NTproBNP), a marker of death and HF. Methods: We measured plasma CT-proET-1 and NTproBNP in 983 consecutive post-AMI patients (721 men, mean age 65.0±(SD)12.2 years), 3-5 days after chest pain onset. Results: There were 101 deaths and 49 readmissions with HF during follow up (median 343, range 0-764 days). CT-proET-1 was raised in patients with death or HF compared to survivors (median [range]pmol/L, 119.0[14.0-671.0] vs. 73.0[4.6-431.0]; p<0.0001). Using a Cox proportional hazards logistic model, log CT-proET-1 (HR 6.82) and log NTproBNP (HR 2.62) were significant independent predictors of death or HF (along with age, gender, past history of AMI and therapy with beta blockers). The areas under the receiver-operating curve (AUC) for CT-proET-1, NTproBNP and the logistic model with both markers were 0.76, 0.76 and 0.81 respectively. Findings were similar for death and HF as individual endpoints. Conclusion: The endothelin system is known to be activated post-AMI. CT-proET-1 is a powerful predictor of adverse outcome along with NTproBNP. CT-proET-1 may represent a clinically useful marker of prognosis after AMI

Plasma N-terminal B-type natriuretic peptide as an indicator of long-term survival after acute myocardial infarction: Comparison with plasma midregional pro-atrial natriuretic peptide

Plasma N-terminal B-type natriuretic peptide as an indicator of long-term survival after acute myocardial infarction: Comparison with plasma midregional pro-atrial natriuretic peptid