In 93% of 2247 consecutive patients with suspected
ST-elevation myocardial infarction admitted at two tertiary heart centres, admission plasma levels of pro-
atrial natriuretic peptide, copeptin, mid-regional pro-
adrenomedullin and stimulation-2 were measured on hospital admission. Patients were stratified according to no
cardiogenic shock development and
cardiogenic shock developed before (early
cardiogenic shock) or after (late
cardiogenic shock) leaving the catheterization laboratory. In total, 225 (10%) patients developed
cardiogenic shock, amongst these patients late
cardiogenic shock occurred in 64 (2.9%). All four
biomarkers were independently associated with the development of late
cardiogenic shock (odds ratio per two-fold increase in risk: 1.19-3.13) even when adjusted for the recently developed Observatoire Régional Breton sur l'Infarctus risk score for prediction of late
cardiogenic shock development. Furthermore, pro-
atrial natriuretic peptide, copeptin and mid-regional pro-
adrenomedullin, but not stimulation-2, added significant predictive information, when added to the Observatoire Régional Breton sur l'Infarctus risk score (area under the receiver-operating characteristic curve, pro-
atrial natriuretic peptide: 0.87, p=0.0008; copeptin: 0.86, p<0.05; mid-regional pro-
adrenomedullin: 0.88, p=0.006).
CONCLUSIONS: