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Malondialdehyde-modified LDL as a marker of acute coronary syndromes.
JAMA. 1999 May 12; 281(18):1718-21.JAMA

Abstract

CONTEXT

Release of circulating malondialdehyde (MDA)-modified low-density lipoprotein (LDL) may reflect endothelial injury or plaque instability.

OBJECTIVE

To determine the usefulness of MDA-modified LDL for identifying patients with unstable angina and acute myocardial infarction (AMI).

DESIGN

Blinded comparison of MDA-modified LDL, C-reactive protein, and troponin I followed by multiple receiver operating curve analysis.

SETTING

University hospital.

PARTICIPANTS

A total of 104 consecutive patients with acute coronary syndromes (42 with unstable angina and 62 with AMI), and 64 patients with stable coronary artery disease (CAD) without evidence of ischemia.

MAIN OUTCOME MEASURES

Ability of MDA-modified LDL, C-reactive protein, and troponin I to discriminate patients with stable CAD, unstable angina, or AMI.

RESULTS

Malondialdehyde-modified LDL (chi2 = 10.2; P = .001), but not troponin I or C-reactive protein, discriminated between stable CAD and unstable angina. Troponin I (chi2 = 14.5; P<.001), but not MDA-modified LDL or C-reactive protein, discriminated between unstable angina and AMI. Both MDA-modified LDL and troponin I (chi2 = 14.5; P<.001 and chi2 = 5.3; P = .02, respectively) but not C-reactive protein discriminated between stable CAD and AMI. The sensitivity of MDA-modified LDL was 95% for unstable angina and 95% for AMI, with a specificity of 95%. Values for troponin I were 38% and 90%, respectively, with a specificity of 95%. The combination of MDA-modified LDL and troponin I had a sensitivity of 98% for unstable angina and 100% for AMI, with a specificity of 99%.

CONCLUSION

The combination of MDA-modified LDL, which may reflect endothelial injury or plaque instability, and troponin I, which reflects myocardial cell injury, allows better discrimination between stable CAD and acute coronary syndromes than troponin I alone.

Authors+Show Affiliations

Center for Molecular and Vascular Biology, University of Leuven, Belgium. paul.holvoet@med.kuleuven.ac.beNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

10328072

Citation

Holvoet, P, et al. "Malondialdehyde-modified LDL as a Marker of Acute Coronary Syndromes." JAMA, vol. 281, no. 18, 1999, pp. 1718-21.
Holvoet P, Collen D, Van de Werf F. Malondialdehyde-modified LDL as a marker of acute coronary syndromes. JAMA. 1999;281(18):1718-21.
Holvoet, P., Collen, D., & Van de Werf, F. (1999). Malondialdehyde-modified LDL as a marker of acute coronary syndromes. JAMA, 281(18), 1718-21.
Holvoet P, Collen D, Van de Werf F. Malondialdehyde-modified LDL as a Marker of Acute Coronary Syndromes. JAMA. 1999 May 12;281(18):1718-21. PubMed PMID: 10328072.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Malondialdehyde-modified LDL as a marker of acute coronary syndromes. AU - Holvoet,P, AU - Collen,D, AU - Van de Werf,F, PY - 1999/5/18/pubmed PY - 2001/8/14/medline PY - 1999/5/18/entrez SP - 1718 EP - 21 JF - JAMA JO - JAMA VL - 281 IS - 18 N2 - CONTEXT: Release of circulating malondialdehyde (MDA)-modified low-density lipoprotein (LDL) may reflect endothelial injury or plaque instability. OBJECTIVE: To determine the usefulness of MDA-modified LDL for identifying patients with unstable angina and acute myocardial infarction (AMI). DESIGN: Blinded comparison of MDA-modified LDL, C-reactive protein, and troponin I followed by multiple receiver operating curve analysis. SETTING: University hospital. PARTICIPANTS: A total of 104 consecutive patients with acute coronary syndromes (42 with unstable angina and 62 with AMI), and 64 patients with stable coronary artery disease (CAD) without evidence of ischemia. MAIN OUTCOME MEASURES: Ability of MDA-modified LDL, C-reactive protein, and troponin I to discriminate patients with stable CAD, unstable angina, or AMI. RESULTS: Malondialdehyde-modified LDL (chi2 = 10.2; P = .001), but not troponin I or C-reactive protein, discriminated between stable CAD and unstable angina. Troponin I (chi2 = 14.5; P<.001), but not MDA-modified LDL or C-reactive protein, discriminated between unstable angina and AMI. Both MDA-modified LDL and troponin I (chi2 = 14.5; P<.001 and chi2 = 5.3; P = .02, respectively) but not C-reactive protein discriminated between stable CAD and AMI. The sensitivity of MDA-modified LDL was 95% for unstable angina and 95% for AMI, with a specificity of 95%. Values for troponin I were 38% and 90%, respectively, with a specificity of 95%. The combination of MDA-modified LDL and troponin I had a sensitivity of 98% for unstable angina and 100% for AMI, with a specificity of 99%. CONCLUSION: The combination of MDA-modified LDL, which may reflect endothelial injury or plaque instability, and troponin I, which reflects myocardial cell injury, allows better discrimination between stable CAD and acute coronary syndromes than troponin I alone. SN - 0098-7484 UR - https://www.unboundmedicine.com/medline/citation/10328072/Malondialdehyde_modified_LDL_as_a_marker_of_acute_coronary_syndromes_ L2 - https://jamanetwork.com/journals/jama/fullarticle/vol/281/pg/1718 DB - PRIME DP - Unbound Medicine ER -