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TMAO MI Clin Chem Accepted Manuscript.pdf (909.89 kB)

Trimethylamine N-oxide and Risk Stratification after Acute Myocardial Infarction

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journal contribution
posted on 2016-11-23, 16:55 authored by Toru Suzuki, Liam M. Heaney, Donald J. L. Jones, Leong L. Ng
Background: Risk stratification in acute myocardial infarction (MI) remains a clinical challenge. Trimethylamine N-oxide (TMAO), a gut-derived metabolite, was investigated for its ability to assist in risk stratification for acute MI hospitalizations. Methods: TMAO was analyzed in 1079 acute MI patients. Associations with adverse outcome of all-cause mortality or reinfarction (death/MI) for shorter (6-month) and longer (2-year) terms were assessed and compared to other cohort-specific biomarkers. Added value in risk stratification by combined use with the Global Registry of Acute Coronary Events (GRACE) score was also investigated. Results: TMAO independently predicted death/MI at 2 years [292 events, hazard ratio 1.21 (95% CI, 1.03–1.43), P = 0.023], but was not able to predict death/MI at 6 months (161 events, P = 0.119). For death/MI at 2 years, TMAO retained independent prediction of risk (P = 0.034) and improved stratification even after addition of multiple alternative and contemporary biomarkers previously shown to provide added prognostic value in this cohort. From these contemporary biomarkers, TMAO remained the only significant predictor of outcome. Further, TMAO improved risk stratification for death/MI at 6 months by down-classifying risk in patients with GRACE score >119 and plasma TMAO concentration ≤3.7 μ mol/L. Conclusions: TMAO levels showed association with poor prognosis (death/MI) at 2 years and superiority over contemporary biomarkers for patients hospitalized due to acute MI. Furthermore, when used with the GRACE score for calculating risk at 6 months, TMAO reidentified patients at lower risk after initial categorization into a higher-risk group and showed usefulness as a secondary risk stratification biomarker.

History

Citation

Clinical Chemistry, 2017, 63 (1), pp. 420-428

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

Clinical Chemistry

Publisher

American Association for Clinical Chemistry

issn

1530-8561;0009-9147

Acceptance date

2016-09-19

Copyright date

2016

Available date

2017-11-30

Publisher version

http://clinchem.aaccjnls.org/content/63/1/420

Notes

The file associated with this record is under a 12 month embargo from publication in accordance with the publisher's self-archiving policy. The full text may be available through the publisher links provided above.

Language

en

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