TY - JOUR
T1 - Biomarkers predictive of late cardiogenic shock development in patients with suspected ST-elevation myocardial infarction
AU - Frydland, Martin
AU - Møller, Jacob E
AU - Lindholm, Matias G
AU - Hansen, Rikke
AU - Wiberg, Sebastian
AU - Lerche Helgestad, Ole Kristian
AU - Thomsen, Jakob H
AU - Goetze, Jens P
AU - Engstrøm, Thomas
AU - Frikke-Schmidt, Ruth
AU - Ravn, Hanne B
AU - Holmvang, Lene
AU - Jensen, Lisette O
AU - Kjaergaard, Jesper
AU - Hassager, Christian
PY - 2020/9
Y1 - 2020/9
N2 - BACKGROUND: Cardiogenic shock complicating ST-elevation myocardial infarction is characterised by progressive left ventricular dysfunction causing inflammation and neurohormonal activation. Often, cardiogenic shock develops after hospital admission. Whether inflammation and a neurohormonal activation precede development of clinical cardiogenic shock is unknown.METHODS AND RESULTS: In 93% of 2247 consecutive patients with suspected ST-elevation myocardial infarction admitted at two tertiary heart centres, admission plasma levels of pro-atrial natriuretic peptide, copeptin, mid-regional pro-adrenomedullin and stimulation-2 were measured on hospital admission. Patients were stratified according to no cardiogenic shock development and cardiogenic shock developed before (early cardiogenic shock) or after (late cardiogenic shock) leaving the catheterization laboratory. In total, 225 (10%) patients developed cardiogenic shock, amongst these patients late cardiogenic shock occurred in 64 (2.9%). All four biomarkers were independently associated with the development of late cardiogenic shock (odds ratio per two-fold increase in risk: 1.19-3.13) even when adjusted for the recently developed Observatoire Régional Breton sur l'Infarctus risk score for prediction of late cardiogenic shock development. Furthermore, pro-atrial natriuretic peptide, copeptin and mid-regional pro-adrenomedullin, but not stimulation-2, added significant predictive information, when added to the Observatoire Régional Breton sur l'Infarctus risk score (area under the receiver-operating characteristic curve, pro-atrial natriuretic peptide: 0.87, p=0.0008; copeptin: 0.86, p<0.05; mid-regional pro-adrenomedullin: 0.88, p=0.006).CONCLUSIONS: Pro-atrial natriuretic peptide, copeptin, mid-regional pro-adrenomedullin and stimulation-2 admission plasma concentration were associated with late cardiogenic shock development in patients admitted with suspected ST-elevation myocardial infarction. Pro-atrial natriuretic peptide, mid-regional pro-adrenomedullin and copeptin had independent predictive value for late cardiogenic shock development.
AB - BACKGROUND: Cardiogenic shock complicating ST-elevation myocardial infarction is characterised by progressive left ventricular dysfunction causing inflammation and neurohormonal activation. Often, cardiogenic shock develops after hospital admission. Whether inflammation and a neurohormonal activation precede development of clinical cardiogenic shock is unknown.METHODS AND RESULTS: In 93% of 2247 consecutive patients with suspected ST-elevation myocardial infarction admitted at two tertiary heart centres, admission plasma levels of pro-atrial natriuretic peptide, copeptin, mid-regional pro-adrenomedullin and stimulation-2 were measured on hospital admission. Patients were stratified according to no cardiogenic shock development and cardiogenic shock developed before (early cardiogenic shock) or after (late cardiogenic shock) leaving the catheterization laboratory. In total, 225 (10%) patients developed cardiogenic shock, amongst these patients late cardiogenic shock occurred in 64 (2.9%). All four biomarkers were independently associated with the development of late cardiogenic shock (odds ratio per two-fold increase in risk: 1.19-3.13) even when adjusted for the recently developed Observatoire Régional Breton sur l'Infarctus risk score for prediction of late cardiogenic shock development. Furthermore, pro-atrial natriuretic peptide, copeptin and mid-regional pro-adrenomedullin, but not stimulation-2, added significant predictive information, when added to the Observatoire Régional Breton sur l'Infarctus risk score (area under the receiver-operating characteristic curve, pro-atrial natriuretic peptide: 0.87, p=0.0008; copeptin: 0.86, p<0.05; mid-regional pro-adrenomedullin: 0.88, p=0.006).CONCLUSIONS: Pro-atrial natriuretic peptide, copeptin, mid-regional pro-adrenomedullin and stimulation-2 admission plasma concentration were associated with late cardiogenic shock development in patients admitted with suspected ST-elevation myocardial infarction. Pro-atrial natriuretic peptide, mid-regional pro-adrenomedullin and copeptin had independent predictive value for late cardiogenic shock development.
KW - Aged
KW - Atrial Natriuretic Factor/blood
KW - Biomarkers/blood
KW - Female
KW - Follow-Up Studies
KW - Humans
KW - Male
KW - Natriuretic Peptide, Brain/blood
KW - Prognosis
KW - ROC Curve
KW - Retrospective Studies
KW - ST Elevation Myocardial Infarction/blood
KW - Shock, Cardiogenic/blood
U2 - 10.1177/2048872619896063
DO - 10.1177/2048872619896063
M3 - Journal article
C2 - 31961195
SN - 2048-8726
VL - 9
SP - 557
EP - 566
JO - European Heart Journal: Acute Cardiovascular Care
JF - European Heart Journal: Acute Cardiovascular Care
IS - 6
ER -