University of Leicester
Browse
1/1
2 files

Pro-substance p for evaluation of risk in acute myocardial infarction.

journal contribution
posted on 2015-04-21, 13:27 authored by Leong L. Ng, Jatinderpal K. Sandhu, Hafid Narayan, Paulene A. Quinn, Iain B. Squire, Joan E. Davies, J. Struck, A. Bergmann, A. Maisel, Donald J.L. Jones
Background Pro-substance P (ProSP) is a stable surrogate marker for labile substance P, which has pro-inflammatory effects, increases platelet aggregation and clot strength, and reduces fibrinolysis. Objectives This study assessed whether ProSP was associated with poor prognosis after acute myocardial infarction (AMI) to identify novel pathophysiological mechanisms. Methods ProSP was measured in 1,148 AMI patients (825 men, mean age 66.2 ± 12.8 years). Endpoints were major adverse cardiac events (composite of death, reinfarction, and heart failure [HF] hospitalization), death/reinfarction, and death/HF. GRACE (Global Registry of Acute Coronary Events) scores were compared with ProSP for death and/or reinfarction at 6 months. Results During 2-year follow-up, there were 140 deaths, 112 HF hospitalizations, and 149 re-AMI. ProSP levels were highest on the first 2 days after admission and related to estimated glomerular filtration rate, age, history of diabetes, ischemic heart disease or hypertension, Killip class, left ventricular wall motion index, and sex. Multivariate Cox regression models showed ProSP level was a predictor of major adverse events (hazard ratio [HR]: 1.30; 95% confidence interval [CI]: 1.10 to 1.54; p < 0.002), death and/or AMI (HR: 1.42; 95% CI: 1.20 to 1.68; p < 0.0005), death and/or HF (HR: 1.38; 95% CI: 1.14 to 1.67; p < 0.001). ProSP levels with GRACE scores were independent predictors of 6-month death and/or reinfarction (p < 0.0005 for both). ProSP-adjusted GRACE scores reclassified patients significantly (overall category-free net reclassification improvement of 31.6 (95% CI: 14.3 to 49.0; p < 0.0005) mainly by down-classifying those without endpoints. Conclusions ProSP levels post-AMI are prognostic for death, recurrent AMI, or HF, and they improve risk prediction of GRACE scores, predominantly by down-classifying risk in those without events.

Funding

This work was supported by the John and Lucille Van Geest Foundation and the National Institute for Health Research Leicester Cardiovascular Biomedical Research Unit.

History

Citation

Journal of the American College of Cardiology, 2014, 64 (16), pp. 1698-1707

Author affiliation

/Organisation/COLLEGE OF MEDICINE, BIOLOGICAL SCIENCES AND PSYCHOLOGY/School of Medicine/Department of Cancer Studies and Molecular Medicine

Version

  • AM (Accepted Manuscript)

Published in

Journal of the American College of Cardiology

Publisher

Elsevier for the American College of Cardiology

issn

0735-1097

eissn

1558-3597

Copyright date

2014

Available date

2015-10-21

Publisher version

http://www.sciencedirect.com/science/article/pii/S0735109714057775

Language

en