Comparison of long-term prognostic value of N-terminal-proBNP and midregional-pro-adrenomedullin in patients with acute myocardial infarction

Thomas Walter, Martina Brueckmann, Siegfried Lang, Tamara Sauer, Esther Fiedler, Jana Papassotiriou, Michael Behnes, Elif Elmas, Martin Borggrefe, Thomas Bertsch
Clinical Laboratory 2010, 56 (7-8): 303-9

BACKGROUND: N-terminal-proBNP (NT-proBNP) and Midregional-pro-Adrenomedullin (MR-proADM) predict mortality of patients with acute myocardial infarction (AMI). Comparison of the prognostic values of NT-proBNP and MR-proADM to predict long-term adverse clinical events (AE) after AMI has not been evaluated yet.

METHODS: 30 patients with AMI were enrolled into this prospective study. Measurements of NT-proBNP and MR-proADM were performed at initial presentation, two or three days and four months after AMI. Long-term AE defined as recurrent AMI, need for repeated percutaneous transluminal angioplasty or coronary bypass graft surgery, congestive heart failure, cardiopulmonary resuscitation, cardiogenic shock, syncope, and death were documented during a follow-up period of ten months.

RESULTS: At initial presentation, NT-proBNP values were significantly higher in patients with AE compared to patients without AE (p < 0.05). The area under the ROC curve (AUC) indicated good predictive performance of NT-proBNP (AUC 0.78, 95% CI 0.59-0.91, p = 0.003) and MR-proADM (AUC 0.71, 95% CI 0.51-0.86, p = 0.046) regarding AE. Comparing both AUC revealed no differences between NT-proBNP and MR-proADM as predictors of AE (p = 0.59). Patients with NT-proBNP levels > or = 370 pg/mL were more likely to suffer from AE than patients with lower levels (relative risk 6.7, 95% CI 1.0-46, p = 0.018). With this cutoff, NT-proBNP could exclude AE with a negative predictive value of 92% being similar to MR-proADM (negative predictive value 76%, relative risk 2.8, 95% CI 1.2-6.9, p = 0.042).

CONCLUSIONS: Early measurements of NT-proBNP or MR-proADM during the acute phase of AMI may allow the risk of a long-term AE to be excluded, based on the comparable test characteristics,.

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