Biomarkers predictive of late cardiogenic shock development in patients with suspected ST-elevation myocardial
Martin Frydland1, Jacob E Møller1,2, Matias G Lindholm1
1Department of Cardiology, Copenhagen University Hospital, Denmark.
Insights
Biomarkers like pro-atrial natriuretic peptide, copeptin, and mid-regional pro-adrenomedullin measured on admission can predict late cardiogenic shock in ST-elevation myocardial infarction patients. These markers offer valuable insights into predicting shock development post-hospitalization.
Area of Science:
- Cardiology
- Biomarker Research
- Myocardial Infarction
Background:
- Cardiogenic shock in ST-elevation myocardial infarction (STEMI) involves left ventricular dysfunction, inflammation, and neurohormonal activation.
- The timing of inflammation and neurohormonal activation relative to clinical cardiogenic shock onset is not well understood.
- Late-onset cardiogenic shock, developing after hospital admission, presents a specific clinical challenge.
Purpose of the Study:
- To investigate whether specific biomarkers measured on hospital admission can predict the development of late cardiogenic shock in patients with suspected STEMI.
- To assess the independent predictive value of these biomarkers beyond existing risk scores.
Main Methods:
- Analysis of admission plasma levels of four biomarkers: pro-atrial natriuretic peptide, copeptin, mid-regional pro-adrenomedullin, and stimulation-2.
- Stratification of 2247 STEMI patients into groups with no shock, early shock, and late shock.
- Statistical analysis including multivariable regression and assessment of predictive information added to the Observatoire Régional Breton sur l'Infarctus risk score.
Main Results:
- All four biomarkers were independently associated with late cardiogenic shock development.
- Pro-atrial natriuretic peptide, copeptin, and mid-regional pro-adrenomedullin demonstrated significant added predictive value when incorporated into the existing risk score.
- These biomarkers showed strong predictive capabilities, with areas under the ROC curve ranging from 0.86 to 0.88.
Conclusions:
- Admission plasma concentrations of pro-atrial natriuretic peptide, copeptin, mid-regional pro-adrenomedullin, and stimulation-2 are associated with late cardiogenic shock in STEMI patients.
- Pro-atrial natriuretic peptide, mid-regional pro-adrenomedullin, and copeptin possess independent predictive value for identifying patients at risk of developing late cardiogenic shock.
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.
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