Abstract 3745: Asymmetric Dimethylarginine and Mortality after Acute Myocardial Infarction

Abstract

Background . From a prospective cohort of patients with acute myocardial infarction (MI), we aimed to analyse the predictive value of ADMA concentrations on mortality at 1 year follow-up. ADMA is an endogenous competitive inhibitor of NO synthases. Patients . Blood samples from 204 consecutive patients hospitalised for acute MI < 24 hr were taken on admission. Serum levels of ADMA, its stereoisomer, symmetric dimethylarginine (SDMA), were determined using high-performance liquid chromatography and fluorescence. Results . The mean (SD) ADMA level was 1.07(0.37) μmol/L. ADMA was positively related to age, homocysteine, SDMA and L-arginine. The glomerular filtration rate (GFR) showed a trend toward an inverse relation with ADMA. ADMA concentrations showed a trend towards a higher level in women than in men (p=.101) and were lower in current smokers vs past or non smokers (p=0.022). Baseline ADMA and SDMA levels were higher in patients who had died than in patients who were alive at 1 year follow-up (respectively 1.22(1.06–1.54) vs 0.98(0.78–1.24), p=0.012 and 0.77(0.54–1.03) vs 0.47(0.35–0.64), p<0.001). By Cox stepwise multivariate analysis, high levels of ADMA were one of the strongest predictors for mortality (HR(95%CI), 6.63(2.55–17.21)), even when adjusted for potential confounders, such as biological and clinical factors, and reperfusion. In contrast, SDMA failed to independently predict the outcome (HR(95%CI): 1.88(0.33–10.70). Conclusion . Our study suggests that measurement of ADMA levels at baseline improves cardiovascular risk prediction after acute MI, beyond traditional risk factors and biomarkers. ADMA may thus constitute a novel and useful marker for risk stratification in acute MI.