We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Midregional Proadrenomedullin Predicts Mortality and Major Adverse Cardiac Events in Patients Presenting With Chest Pain: Results From the CHOPIN Trial.
- Authors
Shah, Kevin S.; Marston, Nicholas A.; Mueller, Christian; Neath, Sean‐Xavier; Christenson, Robert H.; McCord, James; Nowak, Richard M.; Vilke, Gary M.; Daniels, Lori B.; Hollander, Judd E.; Apple, Fred S.; Cannon, Chad M.; Nagurney, John; Schreiber, Donald; deFilippi, Christopher; Hogan, Christopher J.; Diercks, Deborah B.; Limkakeng, Alexander; Anand, Inder S.; Wu, Alan H. B.
- Abstract
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-pro ADM) 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-pro ADM 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-pro ADM 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-pro ADM, history of coronary artery disease ( CAD), and hypertension were predictors of short-term MACE, while history of CAD, hypertension, cTnI, and MR-pro ADM were predictors of long-term MACE. Conclusions In patients with chest pain, MR-pro ADM 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.
- Subjects
ANGINA pectoris; CHEST pain diagnosis; HEART disease risk factors; MYOCARDIAL infarction diagnosis; ASPIRIN; BIOMARKERS; BIOLOGICAL assay; CONFIDENCE intervals; CORONARY disease; DIFFUSION of innovations; EMERGENCY medicine; CARDIAC patients; HOSPITAL care; RACE; T-test (Statistics); COMORBIDITY; DATA analysis; RECEIVER operating characteristic curves; DATA analysis software; DESCRIPTIVE statistics; KAPLAN-Meier estimator; ODDS ratio; MANN Whitney U Test; DIAGNOSIS
- Publication
Academic Emergency Medicine, 2015, Vol 22, Issue 5, p554
- ISSN
1069-6563
- Publication type
Article
- DOI
10.1111/acem.12649