• Philip Haaf, Raphael Twerenbold, Tobias Reichlin, Jonathan Faoro, Miriam Reiter, Christophe Meune, Stephan Steuer, Stefano Bassetti, Ronny Ziller, Cathrin Balmelli, Isabel Campodarve, Christa Zellweger, Ashley Kilchenmann, Affan Irfan, Jana Papassotiriou, Beatrice Drexler, and Christian Mueller.
• Department of Internal Medicine, Division of Cardiology, University Hospital, Basel, Switzerland.
• Int. J. Cardiol. 2013 Sep 30;168(2):1048-55.

BackgroundThe purpose of this study was to investigate the utility of mid-regional pro-adrenomedullin (MR-proADM) in the early diagnosis and risk stratification of patients with acute chest pain in comparison with established and novel biomarkers and risk scores.MethodsIn this prospective, observational, international, multi-center trial (APACE), MR-proADM was determined in 1179 unselected patients with acute chest pain. Patients were followed for 24 months.ResultsMR-proADM concentrations at presentation were higher in patients with AMI (median: 0.78 nmol/l, IQR 0.60-1.13) than in patients with other diagnoses (0.64 nmol/l, IQR 0.49-0.86 nmol/l; p<0.001). The diagnostic accuracy of MR-proADM for AMI as quantified by the area under the receiver operating characteristic curve (AUC) was 0.66. Adding MR-proADM to hs-cTnT could not improve its diagnostic accuracy for AMI (p=0.431). Seventy-six percent of all deaths occurred in the fourth quartile of MR-proADM (>0.90 nmol/l). Adding MR-proADM to the TIMI-score (AUC 0.87) predicted 1-year mortality more accurately than the TIMI-score alone (AUC 0.82; p<0.001). Net reclassification improvement (TIMI vs. additionally MR-proADM) amounted to 0.137 (p=0.012). MR-proADM had higher prognostic accuracy as compared to hs-cTnT in patients with AMI (p=0.015) and in those without AMI (p=0.003). MR-proADM at presentation was tantamount to GRACE score and BNP as to its prognostic accuracy for mortality. The AUC for the prediction of cardiovascular events amounted to 0.63.ConclusionsWhile MR-proADM does not have clinical utility in the early diagnosis of AMI or predicting cardiovascular events in patients with acute chest pain, it may provide prognostic value for all-cause mortality.Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

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