C-terminal pro–endothelin-1 offers additional prognostic information in patients after acute myocardial infarction : Leicester Acute Myocardial Infarction Peptide (LAMP) Study - 15/08/11
Résumé |
Background |
Endothelin-1 is elevated in heart failure (HF) and after acute myocardial infarction (AMI) and gives prognostic information on mortality. Another part of its precursor, C-terminal pro–endothelin-1 (CT-proET-1), is more stable in circulation and ex vivo. We investigated the cardiovascular prognostic value post-AMI of CT-proET-1 and compared it to N-terminal pro–B-type natriuretic peptide (NTproBNP), a marker of death and HF.
Methods |
We measured plasma CT-proET-1 and NTproBNP in 983 consecutive post-AMI patients (721 men, mean age 65.0 ± [SD] 12.2 years), 3 to 5 days after chest pain onset.
Results |
There were 101 deaths and 49 readmissions with HF during follow-up (median 343, range 0-764 days). C-terminal pro–endothelin-1 was raised in patients with death or HF compared to survivors (median [range] [pmol/L], 119.0 [14.0-671.0] vs 73.0 [4.6-431.0], P < .0001). Using a Cox proportional hazards logistic model, log CT-proET-1 (HR 6.82) and log NTproBNP (HR 2.62) were significant independent predictors of death or HF (along with age, sex, history of AMI, and therapy with β-blockers). The areas under the receiver operating curve for CT-proET-1, NTproBNP, and the logistic model with both markers were 0.76, 0.76, and 0.81 respectively. Findings were similar for death and HF as individual end points.
Conclusion |
The endothelin system is known to be activated post AMI. C-terminal pro–endothelin-1 is a powerful predictor of adverse outcome, along with NTproBNP. CT-proET-1 may represent a clinically useful marker of prognosis after AMI.
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Conflicts of interest: A Bergmann holds ownership in BRAHMS AG, patent rights to the markers of the study and is a member of the board of directors of BRAHMS AG. J Struck holds patent rights to the markers and is an employee of BRAHMS AG. N Morgenthaler is an employee of BRAHMS AG. BRAHMS is a mid-sized company, based in Hennigsdorf, Germany, commercializes immunoassays, and has developed the CT-proET-1 assay, for which it owns patent rights. |
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Dr Sohail Q. Khan is supported by a British Heart Foundation Junior Research Fellowship (FS/03/028/15486). This study was not financed by BRAHMS AG. |
Vol 154 - N° 4
P. 736-742 - octobre 2007 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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