MR‐proADM as a Prognostic Marker in Patients With ST‐Segment–Elevation Myocardial Infarction—DANAMI‐3 (a Danish Study of Optimal Acute Treatment of Patients With STEMI) Substudy

Abstract

BackgroundMidregional proadrenomedullin (MR‐proADM) has demonstrated prognostic potential after myocardial infarction (MI). Yet, the prognostic value of MR‐proADM at admission has not been examined in patients with ST‐segment–elevation MI (STEMI).Methods and ResultsThe aim of this substudy, DANAMI‐3 (The Danish Study of Optimal Acute Treatment of Patients with ST‐segment–elevation myocardial infarction), was to examine the associations of admission concentrations of MR‐proADM with short‐ and long‐term mortality and hospital admission for heart failure in patients with ST‐segment–elevation myocardial infarction. Outcomes were assessed using Cox proportional hazard models and area under the curve using receiver operating characteristics. In total, 1122 patients were included. The median concentration of MR‐proADM was 0.64 nmol/L (25th–75th percentiles, 0.53–0.79). Within 30 days 23 patients (2.0%) died and during a 3‐year follow‐up 80 (7.1%) died and 38 (3.4%) were admitted for heart failure. A doubling of MR‐proADM was, in adjusted models, associated with an increased risk of 30‐day mortality (hazard ratio, 2.67; 95% confidence interval, 1.01–7.11; P=0.049), long‐term mortality (hazard ratio, 3.23; 95% confidence interval, 1.97–5.29; P<0.0001), and heart failure (hazard ratio, 2.71; 95% confidence interval, 1.32–5.58; P=0.007). For 30‐day and 3‐year mortality, the area under the curve for MR‐proADM was 0.77 and 0.78, respectively. For 3‐year mortality, area under the curve (0.84) of the adjusted model marginally changed (0.85; P=0.02) after addition of MR‐proADM.ConclusionsElevation of admission MR‐proADM was associated with long‐term mortality and heart failure, whereas the association with short‐term mortality was borderline significant. MR‐proADM may be a marker of prognosis after ST‐segment–elevation myocardial infarction but does not seem to add substantial prognostic information to established clinical models.Clinical Trial Registration URL: http://www.ClinicalTrials.gov/. Unique identifiers: NCT01435408 and NCT01960933.

Past, Present, and Future of Blood Biomarkers for the Diagnosis of Acute Myocardial Infarction—Promises and Challenges

“…Adrenomedullin is generated from its more stable precursor MR-proADM. In clinical studies, MR-proADM has been shown to significantly increase in AMI patients, particularly in those developing post-AMI heart failure, and high MR-proADM levels have been associated with significant increases in short- and long-term mortality and hospitalization for heart failure following AMI [ 54 , 55 ]. Increased MR-proADM levels have even been proposed as a rule-in criteria for AMI, but its exact value as a diagnostic biomarker in addition to the already established criteria remains to be evaluated.…”

Mid-regional pro-adrenomedullin and lactate dehydrogenase as predictors of left ventricular remodeling in patients with myocardial infarction treated with percutaneous coronary intervention

“…Previous reports presented increased level of MR-proADM in patients with MI and acute heart failure. Results of the DANAMI-3 trial showed that MR-proADM could be a predictor of short and long-term mortality and re-admission for heart failure after MI [33]. In the BACH trial, MR-proADM presented useful diagnostic value for acute heart failure in patients with dyspnea [34].…”

Translational studies of adrenomedullin and related peptides regarding cardiovascular diseases

“…Based on all the existing data, MR-pro ADM appears to remain a subsidiary marker of HF. An intermediate prognostic value of MR-pro ADM in myocardial infarction has also been reported [ 98 – 100 ]. Likewise, interesting observations have been reported for MR-pro ADM regarding catheter ablation, infectious endocarditis, and transcatheter aortic valve replacement [ 101 – 104 ].…”