Shah Kevin S, Marston Nicholas A, Mueller Christian, Neath Sean-Xavier, Christenson Robert H, McCord James, Nowak Richard M, Vilke Gary M, Daniels Lori B, Hollander Judd E, Apple Fred S, Cannon Chad M, Nagurney John, Schreiber Donald, deFilippi Christopher, Hogan Christopher J, Diercks Deborah B, Limkakeng Alexander, Anand Inder S, Wu Alan H B, Clopton Paul, Jaffe Allan S, Peacock W Frank, Maisel Alan S
Department of Internal Medicine, University of California, San Diego, CA.
Department of Cardiology, University Hospital Basel, Basel, Switzerland.
Acad Emerg Med. 2015 May;22(5):554-63. doi: 10.1111/acem.12649. Epub 2015 Apr 23.
Chest pain is a common complaint to emergency departments (EDs) and clinical risk factors are used to predict which patients are at risk for worse outcomes and mortality. The goal was to assess the novel biomarker midregional proadrenomedullin (MR-proADM) in prediction of mortality and major adverse cardiac events (MACE).
This was a subanalysis of the CHOPIN study, a 16-center prospective trial that enrolled 2,071 patients presenting with chest pain within 6 hours of onset. The primary endpoint was 6-month all-cause mortality and the secondary endpoint was 30-day and 6-month MACE: ED visits or hospitalization for acute myocardial infarction, unstable angina, reinfarction, revascularization, and heart failure.
MR-proADM performed similarly to troponin (cTnI; c-statistic = 0.845 and 0.794, respectively) for mortality prediction in all subjects and had similar results in those with noncardiac diagnoses. MR-proADM concentrations were stratified by decile, and the cohort in the top decile had a 9.8% 6-month mortality risk versus 0.9% risk for those in the bottom nine deciles (p < 0.0001). MR-proADM, history of coronary artery disease (CAD), and hypertension were predictors of short-term MACE, while history of CAD, hypertension, cTnI, and MR-proADM were predictors of long-term MACE.
In patients with chest pain, MR-proADM predicts mortality and MACE in all-comers with chest pain and has similar prediction in those with a noncardiac diagnosis. This exploratory analysis is primarily hypotheses-generating and future prospective studies to identify its utility in risk stratification should be considered.
胸痛是急诊科常见的就诊原因，临床风险因素用于预测哪些患者有更差结局和死亡风险。本研究旨在评估新型生物标志物中段前肾上腺髓质素（MR-proADM）在预测死亡率和主要不良心脏事件（MACE）方面的作用。
这是对CHOPIN研究的一项亚分析，CHOPIN研究是一项16中心前瞻性试验，纳入了2071例胸痛发作6小时内就诊的患者。主要终点是6个月全因死亡率，次要终点是30天和6个月的MACE：因急性心肌梗死、不稳定型心绞痛、再梗死、血运重建和心力衰竭而进行的急诊就诊或住院治疗。
在所有受试者中，MR-proADM在预测死亡率方面的表现与肌钙蛋白（cTnI；c统计量分别为0.845和0.794）相似，在非心脏诊断患者中结果也相似。MR-proADM浓度按十分位数分层，最高十分位数组的6个月死亡风险为9.8%，而最低九个十分位数组的风险为0.9%（p<0.0001）。MR-proADM、冠状动脉疾病（CAD）病史和高血压是短期MACE的预测因素，而CAD病史、高血压、cTnI和MR-proADM是长期MACE的预测因素。
在胸痛患者中，MR-proADM可预测所有胸痛患者的死亡率和MACE，在非心脏诊断患者中也有相似的预测能力。这项探索性分析主要是为了提出假设，应考虑开展未来前瞻性研究以确定其在风险分层中的作用。
