Mid-regional pro-adrenomedullin in the early evaluation of acute chest pain patients
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Mid-regional pro-adrenomedullin in the early evaluation of acute chest pain patients. / Haaf, Philip; Twerenbold, Raphael; Reichlin, Tobias; Faoro, Jonathan; Reiter, Miriam; Meune, Christophe; Steuer, Stephan; Bassetti, Stefano; Ziller, Ronny; Balmelli, Cathrin; Campodarve, Isabel; Zellweger, Christa; Kilchenmann, Ashley; Irfan, Affan; Papassotiriou, Jana; Drexler, Beatrice; Mueller, Christian.
In: INT J CARDIOL, Vol. 168, No. 2, 30.09.2013, p. 1048-1055.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Mid-regional pro-adrenomedullin in the early evaluation of acute chest pain patients
AU - Haaf, Philip
AU - Twerenbold, Raphael
AU - Reichlin, Tobias
AU - Faoro, Jonathan
AU - Reiter, Miriam
AU - Meune, Christophe
AU - Steuer, Stephan
AU - Bassetti, Stefano
AU - Ziller, Ronny
AU - Balmelli, Cathrin
AU - Campodarve, Isabel
AU - Zellweger, Christa
AU - Kilchenmann, Ashley
AU - Irfan, Affan
AU - Papassotiriou, Jana
AU - Drexler, Beatrice
AU - Mueller, Christian
N1 - Funding Information: Funding: this work was supported by research grants from the Swiss National Science Foundation ( PP00B-102853 ), the Swiss Heart Foundation , Abbott , Roche , Nanosphere , Siemens , and the Department of Internal Medicine, University Hospital Basel .
PY - 2013/9/30
Y1 - 2013/9/30
N2 - Background: The purpose of this study was to investigate the utility of mid-regional pro-adrenomedullin (MR-proADM) in the early diagnosis and risk stratification of patients with acute chest pain in comparison with established and novel biomarkers and risk scores. Methods: In this prospective, observational, international, multi-center trial (APACE), MR-proADM was determined in 1179 unselected patients with acute chest pain. Patients were followed for 24 months. Results: MR-proADMconcentrations at presentationwere higher in patientswith AMI (median: 0.78 nmol/l, IQR 0.60-1.13) than in patients with other diagnoses (0.64 nmol/l, IQR 0.49-0.86 nmol/l; p<0.001). The diagnostic accuracy of MR-proADM for AMI as quantified by the area under the receiver operating characteristic curve (AUC) was 0.66. Adding MR-proADM to hs-cTnT could not improve its diagnostic accuracy for AMI (p= 0.431). Seventy-six percent of all deaths occurred in the fourth quartile of MR-proADM (>0.90 nmol/l). Adding MR-proADMto the TIMI-score (AUC 0.87) predicted 1-year mortalitymore accurately than the TIMI-score alone (AUC 0.82; p<0.001). Net reclassification improvement (TIMI vs. additionally MR-proADM) amounted to 0.137 (p=0.012). MR-proADM had higher prognostic accuracy as compared to hs-cTnT in patients with AMI (p= 0.015) and in those without AMI (p=0.003). MR-proADM at presentation was tantamount to GRACE score and BNP as to its prognostic accuracy for mortality. The AUC for the prediction of cardiovascular events amounted to 0.63. Conclusions: While MR-proADM does not have clinical utility in the early diagnosis of AMI or predicting cardiovascular events in patients with acute chest pain, it may provide prognostic value for all-cause mortality.
AB - Background: The purpose of this study was to investigate the utility of mid-regional pro-adrenomedullin (MR-proADM) in the early diagnosis and risk stratification of patients with acute chest pain in comparison with established and novel biomarkers and risk scores. Methods: In this prospective, observational, international, multi-center trial (APACE), MR-proADM was determined in 1179 unselected patients with acute chest pain. Patients were followed for 24 months. Results: MR-proADMconcentrations at presentationwere higher in patientswith AMI (median: 0.78 nmol/l, IQR 0.60-1.13) than in patients with other diagnoses (0.64 nmol/l, IQR 0.49-0.86 nmol/l; p<0.001). The diagnostic accuracy of MR-proADM for AMI as quantified by the area under the receiver operating characteristic curve (AUC) was 0.66. Adding MR-proADM to hs-cTnT could not improve its diagnostic accuracy for AMI (p= 0.431). Seventy-six percent of all deaths occurred in the fourth quartile of MR-proADM (>0.90 nmol/l). Adding MR-proADMto the TIMI-score (AUC 0.87) predicted 1-year mortalitymore accurately than the TIMI-score alone (AUC 0.82; p<0.001). Net reclassification improvement (TIMI vs. additionally MR-proADM) amounted to 0.137 (p=0.012). MR-proADM had higher prognostic accuracy as compared to hs-cTnT in patients with AMI (p= 0.015) and in those without AMI (p=0.003). MR-proADM at presentation was tantamount to GRACE score and BNP as to its prognostic accuracy for mortality. The AUC for the prediction of cardiovascular events amounted to 0.63. Conclusions: While MR-proADM does not have clinical utility in the early diagnosis of AMI or predicting cardiovascular events in patients with acute chest pain, it may provide prognostic value for all-cause mortality.
KW - Acute myocardial infarction
KW - Chest pain
KW - GRACE score
KW - Mid-regional pro-adrenomedullin
KW - TIMI-risk score
UR - http://www.scopus.com/inward/record.url?scp=84885290211&partnerID=8YFLogxK
U2 - 10.1016/j.ijcard.2012.10.025
DO - 10.1016/j.ijcard.2012.10.025
M3 - SCORING: Journal article
C2 - 23199555
AN - SCOPUS:84885290211
VL - 168
SP - 1048
EP - 1055
JO - INT J CARDIOL
JF - INT J CARDIOL
SN - 0167-5273
IS - 2
ER -