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Trimethylamine N-oxide and risk stratification after acute myocardial infarction

journal contribution
posted on 2018-06-05, 08:53 authored by Toru Suzuki, Liam HeaneyLiam Heaney, Donald J.L. Jones, Leong L. Ng
© 2016 American Association for Clinical Chemistry. 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 plasmaTMAOconcentration ≤3.7 μmol/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.

Funding

This work was supported by the Practical Research Project for Life-Style related Diseases including Cardiovascular Diseases and Diabetes Mellitus from Japan Agency for Medical Research and Development (AMED) and the University of Tokyo, the John and Lucille van Geest Foundation and the National Institute for Health Research Leicester Cardiovascular Biomedical Research Unit.

History

School

  • Sport, Exercise and Health Sciences

Published in

Clinical Chemistry

Volume

63

Issue

1

Pages

420 - 428

Citation

SUZUKI, T. ...et al., 2017. Trimethylamine N-oxide and risk stratification after acute myocardial infarction. Clinical Chemistry, 63(1), pp. 420-428.

Publisher

© American Association for Clinical Chemistry

Version

  • AM (Accepted Manuscript)

Publisher statement

This work is made available according to the conditions of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) licence. Full details of this licence are available at: https://creativecommons.org/licenses/by-nc-nd/4.0/

Acceptance date

2016-09-19

Publication date

2017-01-01

Notes

This paper is in closed access.

ISSN

0009-9147

eISSN

1530-8561

Language

  • en

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