Midregional proadrenomedullin predicts mortality and major adverse cardiac events in patients presenting with chest pain: Results from the CHOPIN trial

Kevin S. Shah, Nicholas A. Marston, Christian Mueller, Sean Xavier Neath, Robert H. Christenson, James McCord, Richard M. Nowak, Gary M. Vilke, Lori B. Daniels, Judd E. Hollander, Fred S. Apple, Chad M. Cannon, John Nagurney, Donald Schreiber, Christopher Defilippi, Christopher J. Hogan, Deborah B. Diercks, Alexander Limkakeng, Inder S. Anand, Alan H B WuPaul Clopton, Allan S. Jaffe, W. Frank Peacock, Alan S. Maisel

Research output: Contribution to journalArticle

6 Citations (Scopus)

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-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.

Original languageEnglish (US)
Pages (from-to)554-563
Number of pages10
JournalAcademic Emergency Medicine
Volume22
Issue number5
DOIs
StatePublished - May 1 2015

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Chest Pain
Mortality
Hospital Emergency Service
Coronary Artery Disease
Hypertension
Troponin
Unstable Angina
proadrenomedullin
Hospitalization
Heart Failure
Biomarkers
Myocardial Infarction
Prospective Studies

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Midregional proadrenomedullin predicts mortality and major adverse cardiac events in patients presenting with chest pain : Results from the CHOPIN trial. / 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; Clopton, Paul; Jaffe, Allan S.; Peacock, W. Frank; Maisel, Alan S.

In: Academic Emergency Medicine, Vol. 22, No. 5, 01.05.2015, p. 554-563.

Research output: Contribution to journalArticle

Shah, KS, Marston, NA, Mueller, C, Neath, SX, Christenson, RH, McCord, J, Nowak, RM, Vilke, GM, Daniels, LB, Hollander, JE, Apple, FS, Cannon, CM, Nagurney, J, Schreiber, D, Defilippi, C, Hogan, CJ, Diercks, DB, Limkakeng, A, Anand, IS, Wu, AHB, Clopton, P, Jaffe, AS, Peacock, WF & Maisel, AS 2015, 'Midregional proadrenomedullin predicts mortality and major adverse cardiac events in patients presenting with chest pain: Results from the CHOPIN trial', Academic Emergency Medicine, vol. 22, no. 5, pp. 554-563. https://doi.org/10.1111/acem.12649
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 ; Clopton, Paul ; Jaffe, Allan S. ; Peacock, W. Frank ; Maisel, Alan S. / Midregional proadrenomedullin predicts mortality and major adverse cardiac events in patients presenting with chest pain : Results from the CHOPIN trial. In: Academic Emergency Medicine. 2015 ; Vol. 22, No. 5. pp. 554-563.
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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.

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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.

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