Biomarker Aids in Heart Attack Risk Stratification

Mid-regional pro-adrenomedullin level predicts death or heart failure risk in NSTEMI patients

WEDNESDAY, June 30 (HealthDay News) -- Mid-regional pro-adrenomedullin (sAM) levels can predict mortality or heart failure in non-ST-elevation myocardial infarction (NSTEMI) patients, complementing other risk stratification tools, according to a study published in the July 6 issue of the Journal of the American College of Cardiology.

In the Leicester Acute Myocardial Infarction Peptide II study, Onkar S. Dhillon, of the University of Leicester in the United Kingdom, and colleagues measured plasma sAM levels in 745 NSTEMI patients at hospital admission and discharge.

Compared to established normal ranges, the researchers found that sAM levels were increased upon admission (median 0.81 nmol/L) and discharge (median 0.76 nmol/L). Multivariate adjusted Cox regression models revealed that admission and discharge sAM levels were associated with the primary end point, which was a composite of death, heart failure, hospitalization, and recurrent acute myocardial infarction over a mean follow-up of 760 days (hazard ratios, 9.75 and 7.54, respectively). In addition, admission sAM levels were particularly linked to early (less than 30 days) mortality, with admission sAM levels greater than 1.11 nmol/L identifying those at highest risk of mortality. Admission sAM was the only independent predictor of early mortality when compared to N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels and Global Registry of Acute Coronary Events (GRACE) score.

"sAM level is prognostic for death or heart failure. Admission levels are a strong predictor of early mortality and, when >1.11 nmol/L, complements the GRACE score to improve risk stratification," the authors conclude.

Two authors are employees of and one holds ownership in BRAHMS AG, which commercializes immunoassays and owns the patent rights to the Midregional Pro-Adrenomedullin assay. Another author has submitted patent applications on biomarkers of cardiovascular disease.

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Beth Gilbert

Beth Gilbert

Updated on June 30, 2010

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