Clinical InvestigationsAcute Ischemic Heart DiseaseC-terminal pro–endothelin-1 offers additional prognostic information in patients after acute myocardial infarction: Leicester Acute Myocardial Infarction Peptide (LAMP) Study
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Study population
We studied 983 consecutive AMI patients admitted to the Coronary Care Unit of Leicester Royal Infirmary. The study complied with the Declaration of Helsinki and was approved by the local ethics committee; written informed consent was obtained from patients. AMI was diagnosed if a patient had a plasma creatine kinase–MB elevation greater than twice normal or cardiac troponin I level >0.1 ng/mL with at least 1 of the following: chest pain lasting >20 minutes or diagnostic serial
Patient characteristics
The demographic features of the patient population are shown in Table I. Median range of follow-up was 343 days ranging from 0 to 764 days. No patient was lost to follow-up, and the minimum length of follow-up for survivors was 60 days, enabling a censored primary end point of death or HF to be determined at this time point for ROC analysis. During follow-up, 101 patients (10.3%) died, and 49 (5.0%) were readmitted with HF. In 783 patients, the AMI was a STEMI event.
Plasma profile of CT-proET-1 and NTproBNP
Daily blood samples were
Discussion
We have shown, using survival analysis, that CT-proET-1 is a powerful independent predictor of death and HF, with combined levels of CT-proET-1 and NTproBNP performing better at identifying patients with the highest risk for an adverse event than either marker alone. The prognostic ability of CT-proET-1 at predicting death or HF is independent of well-established clinical and biochemical factors including the well-established NTproBNP. This has been borne out in the multivariate analyses with
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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.
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.