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Comparison of Long-Term Prognostic Value of N-terminal-proBNP and Midregional-pro-Adrenomedullin in Patients with Acute Myocardial Infarction by Thomas Walter, Martina Brueckmann , Siegfried Lang, Tamara Sauer, Esther Fiedler, Jana Papassotiriou, Michael Behnes, Elif Elmas, Martin Borggrefe, Thomas Bertsch

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 ≥ 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,.

DOI: Clin. Lab. 2010;56:303-309