Khan Sohail Q, O'Brien Russell J, Struck Joachim, Quinn Paulene, Morgenthaler Nils, Squire Iain, Davies Joan, Bergmann Andreas, Ng Leong L
University of Leicester, Department of Cardiovascular Sciences, Leicester Royal Infirmary, Leicester, United Kingdom.
J Am Coll Cardiol. 2007 Apr 10;49(14):1525-32. doi: 10.1016/j.jacc.2006.12.038. Epub 2007 Mar 26.
This study sought to assess the prognostic impact of midregional pro-adrenomedullin (MR-proADM) after an acute myocardial infarction (AMI).
Adrenomedullin (ADM) is elevated in heart failure (HF) and after AMI. Another part of its precursor, MR-proADM, is more stable in circulation and ex vivo. We investigated the cardiovascular prognostic value after AMI of MR-proADM and compared it with N-terminal pro-B-type natriuretic peptide (NTproBNP), a marker of death and HF.
We measured plasma MR-proADM and NTproBNP in 983 consecutive post-AMI patients (721 men, mean age 65.0 +/- 12.2 years), 3 to 5 days after chest pain onset.
There were 101 deaths and 49 readmissions with HF during follow-up (median 342, range 0 to 764 days). The MR-proADM was increased in patients with death or HF compared with survivors (median 1.19 nmol/l, range 0.09 to 5.39 nmol/l, vs. 0.71 nmol/l, range 0.25 to 6.66 nmol/l, p < 0.0001). Using a multivariate binary logistic model, log MR-proADM (odds ratio 4.22) and log NTproBNP (odds ratio 3.20) were significant independent predictors of death or HF (with creatinine, age, gender, and history of AMI). The areas under the receiver-operating characteristic curve 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 showed the same variables (including log MR-proADM, hazard ratio 3.63; log NTproBNP, hazard ratio 2.67). The MR-proADM provided further risk stratification in those patients who had NTproBNP levels above the median (p < 0.0001). Findings were similar for death and HF as individual end points.
The ADM system is activated after AMI. The MR-proADM is a powerful predictor of adverse outcome, especially in those with an elevated NTproBNP. The MR-proADM may represent a clinically useful marker of prognosis after AMI.
本研究旨在评估急性心肌梗死（AMI）后中段肾上腺髓质素原（MR-proADM）的预后影响。
肾上腺髓质素（ADM）在心力衰竭（HF）和AMI后升高。其前体的另一部分MR-proADM在循环和体外更稳定。我们研究了MR-proADM在AMI后的心血管预后价值，并将其与N端前B型利钠肽（NTproBNP）（一种死亡和HF的标志物）进行比较。
我们在983例连续的AMI后患者（721名男性，平均年龄65.0±12.2岁）胸痛发作后3至5天测量了血浆MR-proADM和NTproBNP。
随访期间有101例死亡和49例因HF再次入院（中位时间342天，范围0至764天）。与幸存者相比，死亡或HF患者的MR-proADM升高（中位数1.19 nmol/l，范围0.09至5.39 nmol/l，vs. 0.71 nmol/l，范围0.25至6.66 nmol/l，p<0.0001）。使用多变量二元逻辑模型，log MR-proADM（比值比4.22）和log NTproBNP（比值比3.20）是死亡或HF的显著独立预测因子（与肌酐、年龄、性别和AMI病史有关）。MR-proADM、NTproBNP以及包含这两种标志物的逻辑模型的受试者工作特征曲线下面积分别为0.77、0.79和0.84。死亡或HF预测因子的Cox模型显示相同的变量（包括log MR-proADM，风险比3.63；log NTproBNP，风险比2.67）。MR-proADM在NTproBNP水平高于中位数的患者中提供了进一步的风险分层（p<0.0001）。对于死亡和HF作为单独终点的结果相似。
AMI后ADM系统被激活。MR-proADM是不良结局的有力预测因子，尤其是在NTproBNP升高的患者中。MR-proADM可能是AMI后临床上有用的预后标志物。
