P1469Comparison prognostic values of coronary flow velocity assessment and ejection fraction during routine echocardiography

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Zagatina ◽  
N Zhuravskaya ◽  
O Guseva ◽  
E Kalinina ◽  
D Shmatov
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Ejection Fraction ◽  
Coronary Arteries ◽  
Acute Coronary Syndromes ◽  
Coronary Flow ◽  
Maximal Velocity ◽  
Coronary Flow Velocity ◽  
Coronary Syndromes

Abstract Background Ejection fraction (EF) is a parameter that has traditionally been used for prognostic aims during echocardiography. However, it is known that its prognostic role is accurate only if EF has clearly decreased. So, in the large group of patients who had no prior myocardial infarction, with normal EF but with severe narrowing of main coronary arteries, it is impossible to predict a high risk of adverse coronary events in the near future with transthoracic echocardiography at rest. The aim of the study was to compare prognostic values of coronary flow velocity assessment and EF during transthoracic echocardiography. Methods A prospective cohort study comprises 747 patients (380 males; age 58+13 years) referred for echocardiography. Left side coronary artery (left main - LM, left descending – LAD, and circumflex arteries -LCx) flows were scanned in addition to conventional echocardiography. Cardiac death, nonfatal myocardial infarction (MI), acute coronary syndrome and revascularization were defined as major adverse cardiac events (MACE). The period of follow-up was 3 years. Results During a median follow-up of 36 months, 192 patients experienced 224 MACE. Twenty-six deaths, 16 non-fatal MI, 2 acute coronary syndromes, 180 revascularizations were observed. EF and maximal velocity in proximal segments of coronary arteries were independents predictors of death/MI/acute coronary syndromes. The maximal velocity had a significantly higher predictive value (p<0.004) in the whole group (Figure 1A) as well as among the patients with near normal/normal EF (Figure 1B, 1C). The maximal velocity had a significantly higher predictive value (p<0.0001) of MACE (Figure 1D). Conclusion Coronary artery scan assessment had the statistically significantly higher predictive accuracy of MACE in comparison with traditional EF in the whole group and in the subgroups with different degrees of decreasing EF.

scholarly journals Prognostic value of non-invasive coronary artery flow velocity assessment in elderly patients

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
E Kalinina ◽  
A Zagatina ◽  
N Zhuravskaya ◽  
D Shmatov
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Elderly Patients ◽  
Flow Velocity ◽  
Coronary Arteries ◽  
Coronary Flow ◽  
Prognostic Value ◽  
Area Under Curve ◽  
Left Coronary Artery ◽  
Maximal Velocity

Abstract Funding Acknowledgements Type of funding sources: None. Background There is a high prevalence of coronary artery disease (CAD) in the elderly population. However, symptoms of CAD are often non-specific. Dyspnoe, non-anginal pains are among the main symptoms in older patients. Exercise tests are of limited feasibility in these patients, due to neuro-muscular weakness, physical deconditioning, and orthopaedic limitations. Pharmacological tests often are contraindicated in a substantial percentage of elderly patients. Some recent studies indicate using local flow acceleration during routine echocardiography has prognostic potential for coronary artery assessments without stress testing. The aim of the study was to define the prognostic value of coronary artery ultrasound assessment in patients ≥75 years old. Methods This is a prospective cohort study. Patients ≥ 75 years old who underwent routine echocardiography with additional scans for coronary arteries over a period of 24 months were included in the study. The study group consisted of 80 patients aged 75-90 years (56 women; mean age 79 ± 4). Initial exams were performed for other reasons, primarily for arterial hypertension. Fifteen patients had known CAD. Death, non-fatal myocardial infarction (MI), and revascularization were defined as major adverse cardiac events (MACE). All patients were followed up with at a median of 32 months. Results There were 34 patients with high local velocities in the left coronary artery. Eight deaths, two non-fatal myocardial infarctions occurred, and 13 revascularizations were performed. With a ROC analysis, a coronary flow velocity &gt;110 cm/s was the best predictor for risk of death (area under curve 0.84 [95% CI 0.74–0.92]; sensitivity 75%; specificity 88%). Only the maximal velocity in proximal left-sided coronary arteries was independently associated with death (HR 1.03, 95% CI 1.01; 1.05; p &lt; 0.002), or death/MI (HR 1.03, 95% CI 1.01; 1.04; p &lt; 0.0001). The cut-off value of 66 cm/s was a predictor of all MACE (area under curve 0.87 [95% CI 0.77–0.94]; sensitivity 80%; specificity 86%). Any causes of death or MI occurred more frequently in patients with velocities of &gt;66 cm/s (27% vs. 2%; p &lt; 0.002). The rates of MACE were 58.0% vs. 2%; p &lt; 0.0000001, respectively. Conclusion The analysis of coronary flow in the left coronary artery during echocardiography can be used as a predictor of outcomes in elderly patients. Maximal velocities in proximal left-sided coronary arteries is independently associated with further death or myocardial infarction.

scholarly journals P1293 Coronary artery flow velocity alteration by transthoracic echo in a group of young adult males

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
O Sukhanova ◽  
A Zagatina ◽  
N Zhuravskaya ◽  
A V Ivanov ◽  
D Shmatov
Keyword(s):  
Cardiovascular Disease ◽  
Coronary Artery ◽  
High Risk ◽  
Ejection Fraction ◽  
Flow Velocity ◽  
Coronary Flow ◽  
Maximal Velocity ◽  
Myocardial Mass ◽  
Coronary Flow Velocity ◽  
Apparently Healthy

Abstract Funding Acknowledgements university Grand Background Atherosclerosis is a chronic and progressive disease that causes high mortality primarily in persons over the age of forty. However, a lot of atherosclerosis cases are only discovered after a fatal cardiovascular event. Several techniques can be used to identify atherosclerosis when it is still in its subclinical stages and at ages before the symptoms of atherosclerosis became marked. The SCORE chart and other scores were developed for this purpose. However, the SCORE chart doesn’t cover the people under 40 years old. A significant portion of patients with a high risk of cardiovascular disease have major cardiac events before reaching 40 years of age. The aim of the study was to define subclinical coronary flow alteration in apparently healthy men between the ages of 30-39. Methods This is part of a study intended to facilitate risk estimation in apparently healthy persons between 30 and 39 years old with no documented cardiovascular disease. Seventy-two consecutive men (34 ± 3 years old) who were assumed healthy, were recruited into the study. A standard cardiology exam; analysis of blood lipids; basic transthoracic echocardiography examination with additional scans of the left main, left anterior descending, and circumflex arteries; and carotid ultrasound were performed. Results Among the study population there were eight obese patients (12.5%), twenty-two (22%) smokers, forty-eight (66%) had dyslipidaemias, and six (8%) had a first-degree relative with known premature coronary or vascular events. All of them had a normal ejection fraction (65 ± 4%) and heart chamber sizes. The mean global longitudinal strain (GLS) was -19.3 ± 2%, myocardial mass index was 77 ± 12 g/m2, and intima-media thickness (IMT) was 0.74 ± 0.19 mm. Intima-media thickening at standard site was found in twelve patients (17%, 95% CI 9-26%), atherosclerosis with pronounced plaques in carotid arteries was diagnosed in twenty-one man (29%, 95% CI 19-40%). The group with atherosclerotic plaques had a higher maximal velocity in coronary arteries (44 ± 16 vs. 33 ± 11 cm/s, p &lt; 0.002) compared to other patients. Ejection fraction (65 ± 5 vs. 65 ± 4 %, p = 0.93), myocardial mass index (81 ± 13 vs. 75 ± 12, g/m2 p = 0.053), and GLS (-19 ± 3 vs. -19 ± 2 %, p = 0.55) were similar. There was a significant correlation between IMT and maximal velocity in coronary arteries (r=-0.44, p &lt; 0.0005). Three patients of atherosclerotic group (14%, 95% CI 3-32%) had coronary flow velocity more than 68 cm/s corresponding significant coronary artery lesions. Conclusion There is a high prevalence of subclinical atherosclerosis among men between the ages of 30 and 39 in a population with a high risk of cardiovascular disease by SCORE chart. Coronary flow velocity assessment could be helpful for detection of coronary lesions in young adult patients with carotid plaques.

scholarly journals 623 Coronary ectasia in different clinical subsets: stable and acute coronary syndromes

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Francesco Donati ◽  
Francesco Bendandi ◽  
Gabriele Ghetti ◽  
Nevio Taglieri
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Coronary Arteries ◽  
Acute Coronary Syndromes ◽  
Plaque Rupture ◽  
High Rate ◽  
Gensini Score ◽  
Coronary Syndrome ◽  
Coronary Ectasia ◽  
Coronary Syndromes

Abstract Aims Coronary artery ectasia (CAE) is not a rare finding in coronary angiography with a prevalence ranging from 1% to 20% according to clinical setting. The aim of this study was to analyse the angiographic differences of coronary ectasia based on admitting diagnosis. Methods and results A cohort study was conducted including patients with angiographic evidence of CAE between January 2016 and December 2020. The study population was divided into two groups according to the clinical presentation: stable coronary artery disease (SCAD) and acute coronary syndrome (ACS). Markis classification, basal thrombolysis in myocardial infarction (TIMI) flow of each coronary artery, associated coronary artery obstruction (CAO), and respective Gensini score were reported. A total of 144 patients were included in this study. No difference were found concerning age or the traditional cardiovascular risk factors. Compared to general population, higher rates of myocardial infarction with non-obstructive coronary arteries (MINOCA) and ischaemia with non-obstructive coronary arteries (INOCA) (31% of the entire ACS cohort and 42% the SCAD group, respectively) were observed. Furthermore, irrespective of lower Gensini score values, MINOCA patients showed significantly more widespread CAE and a more severe impairment of coronary flow compared to SCAD and obstructive ACS patients. Conclusions CAE patients show a surprisingly high rate of acute coronary syndromes with non-obstructive coronary arteries. The extent of the ectatic involvement and its consequences on coronary blood flow could be the base of the higher rate of ACS events observed in this population, recognizing mechanisms other than plaque rupture.

Intraoperative transesophageal assessment of coronary artery flow can predict 5 type myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Zagatina ◽  
M Novikov ◽  
N Zhuravskaya ◽  
V Balakhonov ◽  
S Efremov ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Surgery ◽  
Coronary Artery ◽  
Flow Velocity ◽  
Coronary Flow ◽  
Index Number ◽  
Left Main ◽  
Coronary Flow Velocity ◽  
Before And After ◽  
Flow Velocities

Abstract Background Stenosis of a coronary artery results in an increase in flow velocity in the pathologic segment. Effective grafting should decrease the stenotic native coronary velocity according to hemodynamic law. The range of decreased velocity before and after cardiac surgery can hypothetically reflect the effectiveness of a graft. The aim of the study is to determine if measuring coronary flow velocity changes during coronary artery bypass grafting (CABG) can predict intraoperative myocardial infarction. Methods One hundred sixty-six (166) consecutive patients (121 men, 64±9 years old) referred for cardiac surgery, were prospectively included in the study. A standard basic perioperative transesophageal echocardiography (TEE) examination was performed with additional scans of the left main, left anterior descending (LAD), and circumflex (LCx) arteries' proximal segments. Measurements of coronary flow velocities were performed before and after grafting in the same sites of the arteries. The maximal value of cardiac troponin I (cTnI) after CABG and the additive criteria were accounted for in the analysis as it is described in the expert consensus document for Type 5 myocardial infarction (MI) definition. Results One hundred sixty-three patients (98%) had arterial hypertension, 28 patients (17%) had diabetes mellitus, 35 patients (21%) were currently smokers. The feasibility of coronary flow assessment during cardiac operations was 95%. Before grafting, the mean velocity in the left main artery was 91±49 cm/s, in LAD 101±35 cm/s, and in LCx 117±49 cm/s. There was a significant correlation between changes in coronary flow velocities during operation and the value of cTnI (R=0.34, p&lt;0.0001). Ten patients met the criteria for Type 5 MI. There were no differences in age, body mass index, number of coronary arteries with stenoses, frequency of prior MI, ejection fraction or coronary flow velocity before surgery in patients with and without Type 5 MI. The group of patients with Type 5 MI had an increase in native artery velocities during surgery in comparison with patients without MI, who had a significant decrease in coronary flow velocity after grafting (30±48 vs. −10±30 cm/s; p&lt;0.0006). Increases in native coronary velocities greater than 3 cm/s predicted Type 5 MI with 81% accuracy (sensitivity 88%, specificity 70%). Conclusion Coronary flow velocity assessment during cardiac surgery could predict an elevation of cardiac troponins and Type 5 MI. Funding Acknowledgement Type of funding source: None

Impact on Diabetes Mellitus on the Epicardial Coronary Flow Velocity Assessed by the Thrombolysis in Myocardial Infarction Frame Count

Angiology ◽  
2008 ◽  
Vol 60 (4) ◽  
pp. 431-440 ◽  
Author(s):  
Ahmet Soylu ◽  
Kurtulus Ozdemir ◽  
Mehmet Akif Duzenli ◽  
Mehmet Yazici ◽  
Mehmet Tokac
Keyword(s):  
Diabetes Mellitus ◽  
Myocardial Infarction ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Flow Velocity ◽  
Coronary Arteries ◽  
Coronary Flow ◽  
Coronary Flow Velocity ◽  
And Gender

The aim of this study is to evaluate the effect of type 2 diabetes mellitus on epicardial coronary flow velocity assessed by the thrombolysis in myocardial infarction frame count. The thrombolysis in myocardial infarction frame count was measured in 272 coronary arteries from 101 patients with type 2 diabetes mellitus and in 271 coronary arteries from 104 age- and gender-matched patients without type 2 diabetes mellitus referred for coronary angiography. The thrombolysis in myocardial infarction frame count was measured only in normal arteries or in arteries without significant lesion. By both univariate and multivariate analysis, the thrombolysis in myocardial infarction frame count was not related with either type 2 diabetes mellitus or the duration and glycated hemoglobin levels in the patients with type 2 diabetes mellitus. The thrombolysis in myocardial infarction frame count was significantly associated with body surface area, heart rate, and proximal coronary artery diameter. Type 2 diabetes mellitus did not affect epicardial coronary flow velocity assessed by the thrombolysis in myocardial infarction frame count.

Ticagrelor versus Clopidogrel in high bleeding risk patients presenting with Acute Coronary Syndromes: insights from the multicenter START-ANTIPLATELET registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
F Gragnano ◽  
E Moscarella ◽  
P Calabro' ◽  
A Cesaro ◽  
P.C Pafundi ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndromes ◽  
Bleeding Risk ◽  
Coronary Intervention ◽  
P Value ◽  
Bleeding Events ◽  
P2y12 Inhibitors ◽  
Coronary Syndromes ◽  
High Bleeding Risk

Abstract Background Optimal dual antiplatelet therapy in high bleeding risk (HBR) patients with acute coronary syndromes (ACS) remains debated. Although current guidelines recommend the use of potent P2Y12 inhibitors in these patients (according to the labeled indications), clopidogrel is frequently used in clinical practice based on a perceived advantage in terms of safety in the HBR population. Purpose We sought to investigate the use of clopidogrel versus ticagrelor in consecutive HBR ACS patients and their impact on ischemic and bleeding events at 1 year. Methods ACS patients enrolled in the START-ANTIPLATELET registry with at least 1 HBR criterion were included in the present analysis and stratified according to DAPT type (clopidogrel versus ticagrelor). The primary endpoint was net adverse clinical endpoint (NACE), defined as a composite of all-cause death, myocardial infarction, stroke, and major bleeding. The secondary endpoints were major adverse cardiac and cerebral events (MACE), defined as a composite of all-cause death, myocardial infarction and stroke, each individual component of NACE and MACE, and target vessel revascularization. Results Among a total of 1,209 patients with 1-year follow-up in the registry, 383 patients were considered at HBR, of whom 174 (45.4%) were on clopidogrel and 209 (54.6%) on ticagrelor. Clopidogrel was more likely to be administered in patients at increased ischemic and bleeding risk, while ticagrelor in those undergoing percutaneous coronary intervention. Mean DAPT duration was longer in the ticagrelor group than in the clopidogrel group (10.40±4.29 versus 9.35±5.4; p-value=0.03). At 1-year follow-up, the risk of NACE and MACE events was significantly higher in the clopidogrel than in the ticagrelor group (NACE: HR 1.82; 95% CI 1.07–3.09; p-value=0.02; MACE: HR 1.83; 95% CI 1.04–3.24; p-value=0.03) (Figure). After multivariate adjustment for clinical and procedural characteristics, no difference in NACEs nor MACEs was observed between patients on clopidogrel versus ticagrelor (NACE: adjusted HR 1.27; 95% CI 0.71–2.27; p-value=0.42; MACE: adjusted HR 1.19; 95% CI 0.63–2.24; p-value=0.59) (Figure). Age, number of HBR criteria, and mean DAPT duration were independent predictors of NACEs. Conclusions In a real-world ACS registry, approximately 50% of patients are at HBR and frequently treated with clopidogrel. In HBR ACS patients, no difference was observed in ischemic and bleeding events between clopidogrel and ticagrelor after adjustment for potential confounders. Kaplan-Meier curves at 1-year follow-up. Funding Acknowledgement Type of funding source: None

Abstract 4910: Integrated Approach By Using Coronary Flow Velocity Reserve And Coronary Flow Velocity Patterns In Predicting Long-term Adverse Cardiac Events In Acute Myocardial Infarction

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Myeong Ho Yoon ◽  
Seung-Jea Tahk ◽  
Hong-Seok Lim ◽  
Jin-Sun Park ◽  
Hyeong-Mo Yang ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Flow Velocity ◽  
Coronary Flow ◽  
Integrated Approach ◽  
Left Ventricular ◽  
Cardiac Events ◽  
Coronary Flow Velocity ◽  
Adverse Cardiac Events

Background: The microvascular function was known to be an useful predictor of left ventricular functional changes and clinical outcomes in ST-segment elevation myocardial infarction (STEMI). We evaluated the usefulness of integrated approach by using coronary flow velocity reserve (CFR) and diastolic deceleration time (DDT) in the prediction of long-term major adverse cardiac events in STEMI. Methods and Results: Using an intracoronary Doppler wire, CFR, DDT and hyperemic microvascular resistance index (MVRI) were evaluated in 202 patients with first STEMI received reperfusion therapy within 24 hours after onset of symptoms. Major adverse cardiac events were the composite of cardiac death, recurrent myocardial infarction, congestive heart failure and stroke during an average follow-up period of 60 ± 39 months. Follow-up echocardiography was performed at 12 ± 9 months. CFR, DDT and MVRI had significant correlations with left ventricular regional wall motion score index at follow-up echocardiography (r =−0.441, p<0.001; r = 0.413, p<0.001; r =−0.485, p<0.001, respectively). Using receiver-operating characteristics analysis, CFR ≤1.3 (sensitivity: 51%, specificity: 78%), DDT ≤577 ms (sensitivity: 72%, specificity: 62%) and MVRI >2.7 (sensitivity: 68%, specificity: 67%) were the best cutoff values in the prediction of occurring the adverse cardiac events. In patients with CFR ≤1.3, DDT ≤577 ms, cardiac events were occurred in 18 patients (40.0 %) of 45 patients, whereas cardiac events were occurred in 12 patients (20.3%) of 59 patients with CFR >1.3 and DDT ≤577 ms or CFR ≤1.3 and DDT >577 ms (p= 0.048), 9 patients (9.1%) of 99 patients with CFR>1.3 and DDT >577 ms (p<0.001). Ejection fraction at admission (p=0.009), MVRI (p =0.002) and DDT (p=0.023) were independent predictors in the prediction of long-term adverse cardiac outcomes during follow-up. Conclusions: Integrated approach by using CFR and DDT was useful in the prediction of long-term adverse cardiac events. MVRI and DDT were strong independent predictors of long-term adverse cardiac events in STEMI patients.

scholarly journals Differences in cardiac microcirculatory wave patterns between the proximal left mainstem and proximal right coronary artery

2008 ◽  
Vol 295 (3) ◽  
pp. H1198-H1205 ◽  
Author(s):  
Nearchos Hadjiloizou ◽  
Justin E. Davies ◽  
Iqbal S. Malik ◽  
Jazmin Aguado-Sierra ◽  
Keith Willson ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Flow Velocity ◽  
Coronary Arteries ◽  
Right Coronary Artery ◽  
Coronary Flow ◽  
Wave Intensity ◽  
Intensity Analysis ◽  
Wave Intensity Analysis ◽  
Coronary Flow Velocity ◽  
Proximal Right Coronary Artery

Despite having almost identical origins and similar perfusion pressures, the flow-velocity waveforms in the left and right coronary arteries are strikingly different. We hypothesized that pressure differences originating from the distal (microcirculatory) bed would account for the differences in the flow-velocity waveform. We used wave intensity analysis to separate and quantify proximal- and distal-originating pressures to study the differences in velocity waveforms. In 20 subjects with unobstructed coronary arteries, sensor-tipped intra-arterial wires were used to measure simultaneous pressure and Doppler velocity in the proximal left main stem (LMS) and proximal right coronary artery (RCA). Proximal- and distal-originating waves were separated using wave intensity analysis, and differences in waves were examined in relation to structural and anatomic differences between the two arteries. Diastolic flow velocity was lower in the RCA than in the LMS (35.1 ± 21.4 vs. 56.4 ± 32.5 cm/s, P < 0.002), and, consequently, the diastolic-to-systolic ratio of peak flow velocity in the RCA was significantly less than in the LMS (1.00 ± 0.32 vs. 1.79 ± 0.48, P < 0.001). This was due to a lower distal-originating suction wave (8.2 ± 6.6 × 103 vs. 16.0 ± 12.2 × 103 W·m−2·s−1, P < 0.01). The suction wave in the LMS correlated positively with left ventricular pressure ( r = 0.6, P < 0.01) and in the RCA with estimated right ventricular systolic pressure ( r = 0.7, P = 0.05) but not with the respective diameter in these arteries. In contrast to the LMS, where coronary flow velocity was predominantly diastolic, in the proximal RCA coronary flow velocity was similar in systole and diastole. This difference was due to a smaller distal-originating suction wave in the RCA, which can be explained by differences in elastance and pressure generated between right and left ventricles.

scholarly journals Oxygen-regulated protein 150 and prognosis following myocardial infarction

2007 ◽  
Vol 112 (9) ◽  
pp. 477-484 ◽  
Author(s):  
Leong L. Ng ◽  
Russell J. O'Brien ◽  
Paulene A. Quinn ◽  
Iain B. Squire ◽  
Joan E. Davies
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Endoplasmic Reticulum ◽  
Odds Ratio ◽  
Acute Coronary Syndromes ◽  
Cox Regression ◽  
Cardiovascular Morbidity ◽  
Prognostic Information ◽  
Coronary Syndromes

ORP150 (oxygen-regulated protein 150) is a chaperonin expressed in tissues undergoing hypoxic or endoplasmic reticulum stress. In the present study, we investigated plasma levels of ORP150 in patients with AMI (acute myocardial infarction) and its relationship with prognosis, together with a known risk marker N-BNP (N-terminal pro-B-type natriuretic peptide). Plasma from 396 consecutive patients with AMI was obtained for measurement of ORP150 and N-BNP. Mortality and cardiovascular morbidity (acute coronary syndromes/heart failure) was determined during follow-up. A specific ORP150 assay detected the 150 kDa protein in plasma extracts, including 3 and 7 kDa fragments. During follow-up (median, 455 days), 43 (10.9%) patients died. Both N-BNP and ORP150 levels were higher in those who died compared with the survivors [N-BNP, 724 (14.5–28840) compared with 6167 (154.9–33884) pmol/l (P<0.0005); ORP150, 257 (5.9–870.9) compared with 331 (93.3–831.8) pmol/l (P<0.001); values are medians (range)]. In a Cox regression model for mortality prediction, both N-BNP (odds ratio, 5.06; P<0.001) and ORP150 (odds ratio, 2.39; P<0.01) added prognostic information beyond creatinine and the use of thrombolytics. A Kaplan–Meier survival analysis revealed that ORP150 added prognostic information to N-BNP, especially in those with supra-median N-BNP levels. A simplified dual-marker approach with both markers below and either above or both above their respective medians effectively stratified mortality risk (log rank statistic for trend, 32.7; P<0.00005). ORP150 levels were not predictive of other cardiovascular morbidity (acute coronary syndromes or heart failure). In conclusion, ORP150 and peptide fragments derived from it are secreted following AMI and provide independent prognostic information on mortality. High levels associated with endoplasmic reticulum/hypoxic stress predict a poor outcome.

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