Plasma adrenomedullin as an indicator of prognosis after acute myocardial infarction

Objective-To elucidate whether prognosis after acute myocardial infarction can be predicted by measuring plasma adrenomedullin, a novel vasorelaxant p eptide. Patients and design-Plasma adrenomedullin concentrations on day 2 after myo cardial infarction were measured in 113 patients with myocardial infarction with other clinical and haemodynamic variables related to mortality. Results-During a mean follow up period of 25 months, 16 patients died of ca rdiac causes. Plasma adrenomedullin concentrations on day 2 increased signi ficantly in patients with myocardial infarction compared with controls (mea n (SD), 12.3 (8.8) v 4.9 (1.0) pmol/l, p < 0.001). Plasma adrenomedullin co rrelated negatively with left ventricular ejection fraction on admission (r = -0.47, p < 0.001), although it did not significantly correlate with any other haemodynamic variable. By univariate Cox proportional hazards analysi s, plasma adrenomedullin, age, coronary reperfusion, maximum creatine kinas e concentrations, pulmonary congestion, pulmonary capillary wedge pressure, cardiac index, and left ventricular ejection fraction were all significant ly related to mortality. Among the noninvasive variables, only plasma adren omedullin was an independent predictor of mortality after myocardial infarc tion (p < 0.05). The Kaplan-Meier survival curves based on the median plasm a adrenomedullin concentration (10.3 pmol/l) showed that patients with high plasma adrenomedullin had a higher mortality than those with low plasma ad renomedullin (p < 0.01). Conclusions-Plasma adrenomedullin on day 2 after myocardial infarction is s trongly associated with long term mortality, and thus may complement standa rd prognostic indicators.