Abstract | OBJECTIVES: METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
|
Authors | Kevin S Shah, Nicholas A Marston, Christian Mueller, Sean-Xavier Neath, Robert H Christenson, James McCord, Richard M Nowak, Gary M Vilke, Lori B Daniels, Judd E Hollander, Fred S Apple, Chad M Cannon, John Nagurney, Donald Schreiber, Christopher deFilippi, Christopher J Hogan, Deborah B Diercks, Alexander Limkakeng, Inder S Anand, Alan H B Wu, Paul Clopton, Allan S Jaffe, W Frank Peacock, Alan S Maisel |
Journal | Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
(Acad Emerg Med)
Vol. 22
Issue 5
Pg. 554-63
(May 2015)
ISSN: 1553-2712 [Electronic] United States |
PMID | 25908114
(Publication Type: Controlled Clinical Trial, Journal Article, Multicenter Study)
|
Copyright | © 2015 by the Society for Academic Emergency Medicine. |
Chemical References |
- Biomarkers
- Hydroxymethylglutaryl-CoA Reductase Inhibitors
- Protein Precursors
- proadrenomedullin
- Adrenomedullin
- Pravastatin
|
Topics |
- Acute Disease
- Adrenomedullin
(blood)
- Aged
- Biomarkers
(blood)
- Chest Pain
(blood)
- Emergency Service, Hospital
- Female
- Heart Failure
(blood, drug therapy, mortality)
- Humans
- Hydroxymethylglutaryl-CoA Reductase Inhibitors
(therapeutic use)
- Male
- Middle Aged
- Pravastatin
(therapeutic use)
- Predictive Value of Tests
- Prognosis
- Prospective Studies
- Protein Precursors
(blood)
- Risk Assessment
- Risk Factors
- Severity of Illness Index
|