TY - JOUR
T1 - Midregional proadrenomedullin predicts mortality and major adverse cardiac events in patients presenting with chest pain
T2 - Results from the CHOPIN trial
AU - Shah, Kevin S.
AU - Marston, Nicholas A.
AU - Mueller, Christian
AU - Neath, Sean Xavier
AU - Christenson, Robert H.
AU - McCord, James
AU - Nowak, Richard M.
AU - Vilke, Gary M.
AU - Daniels, Lori B.
AU - Hollander, Judd E.
AU - Apple, Fred S.
AU - Cannon, Chad M.
AU - Nagurney, John
AU - Schreiber, Donald
AU - Defilippi, Christopher
AU - Hogan, Christopher J.
AU - Diercks, Deborah B.
AU - Limkakeng, Alexander
AU - Anand, Inder S.
AU - Wu, Alan H.B.
AU - Clopton, Paul
AU - Jaffe, Allan S.
AU - Peacock, W. Frank
AU - Maisel, Alan S.
N1 - Publisher Copyright:
© 2015 by the Society for Academic Emergency Medicine.
PY - 2015/5/1
Y1 - 2015/5/1
N2 - Objectives: Chest pain is a common complaint to emergency departments (EDs) and clinical risk factors are used to predict which patients are at risk for worse outcomes and mortality. The goal was to assess the novel biomarker midregional proadrenomedullin (MR-proADM) in prediction of mortality and major adverse cardiac events (MACE). 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.
AB - Objectives: Chest pain is a common complaint to emergency departments (EDs) and clinical risk factors are used to predict which patients are at risk for worse outcomes and mortality. The goal was to assess the novel biomarker midregional proadrenomedullin (MR-proADM) in prediction of mortality and major adverse cardiac events (MACE). 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.
UR - http://www.scopus.com/inward/record.url?scp=84928952086&partnerID=8YFLogxK
U2 - 10.1111/acem.12649
DO - 10.1111/acem.12649
M3 - Article
C2 - 25908114
AN - SCOPUS:84928952086
SN - 1069-6563
VL - 22
SP - 554
EP - 563
JO - Academic Emergency Medicine
JF - Academic Emergency Medicine
IS - 5
ER -