Myeloperoxidase Serum Levels Predict Risk in Patients With Acute Coronary Syndromes

Ovid Technologies (Wolters Kluwer Health) - Tập 108 Số 12 - Trang 1440-1445 - 2003
Stephan Baldus1, Christopher Heeschen1, Thomas Meinertz1, Andreas M. Zeiher1, Jason P. Eiserich1, Thomas Münzel1, Maarten L. Simoons1, Christian W. Hamm1
1From the University of Hamburg, Department of Cardiology, Hamburg, Germany (S.B., T. Münzel, T. Meinertz); Molecular Cardiology, Department of Internal Medicine IV, University of Frankfurt, Frankfurt, Germany (C.H., A.M.Z.); University of California at Davis, Department of Internal Medicine and Department of Human Physiology, Davis, Calif (J.P.E.); Erasmus University, Thoraxcentre, Rotterdam, Netherlands (M.L.S.); and Kerckhoff Heart Center, Bad Nauheim, Germany (C.W.H.).

Tóm tắt

Background— Polymorphonuclear neutrophils (PMNs) have gained attention as critical mediators of acute coronary syndromes (ACS). Myeloperoxidase (MPO), a hemoprotein abundantly expressed by PMNs and secreted during activation, possesses potent proinflammatory properties and may contribute directly to tissue injury. However, whether MPO also provides prognostic information in patients with ACS remains unknown. Methods and Results— MPO serum levels were assessed in 1090 patients with ACS. We recorded death and myocardial infarctions during 6 months of follow-up. MPO levels did not correlate with troponin T, soluble CD40 ligand, or C-reactive protein levels or with ST-segment changes. However, patients with elevated MPO levels (>350 μg/L; 31.3%) experienced a markedly increased cardiac risk (adjusted hazard ratio [HR] 2.25 [1.32 to 3.82]; P =0.003). In particular, MPO serum levels identified patients at risk who had troponin T levels below 0.01 μg/L (adjusted HR 7.48 [95% CI 1.98 to 28.29]; P =0.001). In a multivariate model that included other biochemical markers, troponin T (HR 1.99; P =0.023), C-reactive protein (1.25; P =0.044), vascular endothelial growth factor (HR 1.87; P =0.041), soluble CD40 ligand (HR 2.78; P <0.001), and MPO (HR 2.11; P =0.008) were all independent predictors of the patient’s 6-month outcome. Conclusions— In patients with ACS, MPO serum levels powerfully predict an increased risk for subsequent cardiovascular events and extend the prognostic information gained from traditional biochemical markers. Given its proinflammatory properties, MPO may serve as both a marker and mediator of vascular inflammation and further points toward the significance of PMN activation in the pathophysiology of ACS.

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Ovid Technologies (Wolters Kluwer Health)

Tập 108 Số 12

1440-1445

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