中段前肾上腺髓质素和C端前内皮素-1对急性心肌梗死患者的长期预后价值

Long-term prognostic value of mid-regional pro-adrenomedullin and C-terminal pro-endothelin-1 in patients with acute myocardial infarction.

作者信息

Behnes Michael, Papassotiriou Jana, Walter Thomas, Fiedler Esther, Sauer Tamara, Lang Siegfried, Elmas Elif, Hoffmann Ursula, Borggrefe Martin, Brueckmann Martina

机构信息

1First Department of Medicine, Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany.

出版信息

Clin Chem Lab Med. 2008;46(2):204-11. doi: 10.1515/CCLM.2008.040.

DOI:10.1515/CCLM.2008.040

PMID:18076360

Abstract

BACKGROUND

Mid-regional pro-adrenomedullin (MR-proADM) and endothelin-1 have been shown to predict mortality of patients with acute myocardial infarction. However, the prognostic value of both biomarkers in predicting long-term clinical events after acute myocardial infarction remains unclear.

METHODS

In a prospective study, 30 patients suffering from acute ST elevation myocardial infarction or non-ST elevation myocardial infarction were enrolled. Measurements of MR-proADM and CT-pro-endothelin-1 (CT-proET-1) were performed at initial presentation, 2 or 3 days and 4 months after acute myocardial infarction. Long-term clinical events (e.g., recurrent myocardial infarction, percutaneous transluminal coronary angioplasty, aorto-coronary venous bypass or cardiogenic shock) were documented over a period from the 4th until the 10th month.

RESULTS

Both MR-proADM and CT-proET-1 were able to differentiate patients with subsequent long-term clinical events (n=11) from those without (n=19). At the time of acute myocardial infarction, median MR-proADM level of the event group was 0.69 nmol/L as compared to 0.59 nmol/L of the no-event group (p=0.036). A difference was still observed after 3 days (event group median 0.66 nmol/L; no-event group median 0.57 nmol/L; p=0.022). Accordingly, median CT-proET-1 level was 72.9 pmol/L in the event group as compared to a median of 54.4 pmol/L in patients in the no-event group (p=0.009) 3 days after acute myocardial infarction. Within the acute phase, patients with MR-proADM levels > or =0.67 nmol/L were 3 times more likely (relative risk 2.8; 95% confidence interval 1.2-6.9; p=0.042) to suffer from a future clinical event. The area under the curve (AUC) was 0.71 (95% confidence interval 0.51-0.86; p=0.046). After 3 days, patients with CT-proET-1 levels > or =57 pmol/L were 6 times more likely (relative risk 5.9; 95% confidence interval 0.9-40.4; p=0.036) to suffer from a future clinical event. The AUC was 0.76 (95% confidence interval 0.55-0.90; p=0.015).

CONCLUSIONS

Elevated levels of MR-proADM and CT-proET-1 during the acute phase of myocardial infarction may predict an adverse long-term clinical outcome.

摘要

背景

中段肾上腺髓质素原（MR-proADM）和内皮素-1已被证明可预测急性心肌梗死患者的死亡率。然而，这两种生物标志物在预测急性心肌梗死后长期临床事件方面的预后价值仍不明确。

方法

在一项前瞻性研究中，纳入了30例患有急性ST段抬高型心肌梗死或非ST段抬高型心肌梗死的患者。在急性心肌梗死初次就诊时、2或3天以及4个月时测量MR-proADM和C末端前内皮素-1（CT-proET-1）。记录从第4个月到第10个月期间的长期临床事件（如复发性心肌梗死、经皮冠状动脉腔内血管成形术、主动脉冠状动脉静脉搭桥术或心源性休克）。

结果

MR-proADM和CT-proET-1均能够区分随后发生长期临床事件的患者（n = 11）和未发生该事件的患者（n = 19）。在急性心肌梗死时，事件组的MR-proADM中位数水平为0.69 nmol/L，而无事件组为0.59 nmol/L（p = 0.036）。3天后仍观察到差异（事件组中位数0.66 nmol/L；无事件组中位数0.57 nmol/L；p = 0.022）。相应地,急性心肌梗死后3天，事件组的CT-proET-1中位数水平为72.9 pmol/L，而无事件组患者的中位数为54.4 pmol/L（p = 0.009）。在急性期内，MR-proADM水平≥0.67 nmol/L的患者未来发生临床事件的可能性高出3倍（相对风险2.8；95%置信区间1.2 - 6.9；p = 0.042）。曲线下面积（AUC）为0.71（95%置信区间0.51 - 0.86；p = 0.046）。3天后，CT-proET-1水平≥57 pmol/L的患者未来发生临床事件的可能性高出6倍（相对风险5.9；95%置信区间0.9 - 40.4；p = 0.036）。AUC为0.76（95%置信区间0.55 - 0.90；p = 0.015）。