Urotensin II is raised in acute myocardial infarction and low levels predict risk of adverse clinical outcome in humans

Background UII is elevated in patients with heart failure; however its role in acute myocardial infarction (AMI) is unknown. We sought to compare levels of UII in patients with AMI to controls. We also compared UII to N terminal pro B type natriuretic peptide (NT-BNP) to evaluate whether levels of UII can be used to predict the risk of adverse clinical outcome (ACO). Methods and results 129 patients were studied with serial blood measurements and echocardiogram during their index admission. Plasma concentration of median UII was significantly elevated in AMI compared to controls (median 1.40 vs. 0.42 fmol/ml p < 0.012). Over the median follow up of 102 days (range 0–189) there were 14 deaths and 14 readmissions with AMI or heart failure. Using a Cox proportional hazards model the only independent predictors of ACO were UII (OR 0.29, p = 0.046) and NT-BNP (OR 4.78, p = 0.012) between 73 and 96 h. The Kaplan–Meier survival curve revealed a significantly better clinical outcome in patients with UII above the median compared with UII below the median. Conclusions UII levels are raised in AMI and is an independent predictor of ACO. Patients with a poor outcome mount a lower UII response suggesting a possible cardioprotective role for this peptide.