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Prognostic value of myeloperoxidase in patients with chest pain.

Abstract

BACKGROUND

Inflammation is linked to adverse outcomes in acute coronary syndromes. Myeloperoxidase, an abundant leukocyte enzyme, is elevated in culprit lesions that have fissured or ruptured in patients with sudden death from cardiac causes. Numerous lines of evidence suggest mechanistic links between myeloperoxidase and both inflammation and cardiovascular disease.

METHODS

We assessed the value of plasma levels of myeloperoxidase as a predictor of the risk of cardiovascular events in 604 sequential patients presenting to the emergency department with chest pain.

RESULTS

Initial plasma myeloperoxidase levels predicted the risk of myocardial infarction, even in patients who are negative for troponin T (<0.1 ng per milliliter) at base line (P<0.001). Myeloperoxidase levels at presentation also predicted the risk of major adverse cardiac events (myocardial infarction, the need for revascularization, or death) within 30 days and 6 months after presentation (P<0.001). In patients without evidence of myocardial necrosis (defined as those who were negative for troponin T), the base-line myeloperoxidase levels independently predicted the risk of major adverse coronary events at 30 days (unadjusted 2nd, 3rd, and 4th quartile odds ratios, 2.2 [95 percent confidence interval, 1.1 to 4.6], 4.2 [95 percent confidence interval, 2.1 to 8.4], and 4.1 [95 percent confidence interval, 2.0 to 8.4], respectively) and at 6 months.

CONCLUSIONS

A single initial measurement of plasma myeloperoxidase independently predicts the early risk of myocardial infarction, as well as the risk of major adverse cardiac events in the ensuing 30-day and 6-month periods. Myeloperoxidase levels, in contrast to troponin T, creatine kinase MB isoform, and C-reactive protein levels, identified patients at risk for cardiac events in the absence of myocardial necrosis, highlighting its potential usefulness for risk stratification among patients who present with chest pain.

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  • Authors+Show Affiliations

    ,

    Department of Cell Biology, Cleveland Clinic Foundation, Cleveland 44195, USA.

    , , , , , , , , , ,

    Source

    The New England journal of medicine 349:17 2003 Oct 23 pg 1595-604

    MeSH

    Aged
    Biomarkers
    C-Reactive Protein
    Chest Pain
    Coronary Artery Disease
    Coronary Thrombosis
    Creatine Kinase
    Creatine Kinase, MB Form
    Female
    Humans
    Isoenzymes
    Male
    Middle Aged
    Myocardial Infarction
    Myocardial Revascularization
    Peroxidase
    Prognosis
    Risk
    Troponin T

    Pub Type(s)

    Journal Article
    Research Support, U.S. Gov't, P.H.S.

    Language

    eng

    PubMed ID

    14573731

    Citation

    Brennan, Marie-Luise, et al. "Prognostic Value of Myeloperoxidase in Patients With Chest Pain." The New England Journal of Medicine, vol. 349, no. 17, 2003, pp. 1595-604.
    Brennan ML, Penn MS, Van Lente F, et al. Prognostic value of myeloperoxidase in patients with chest pain. N Engl J Med. 2003;349(17):1595-604.
    Brennan, M. L., Penn, M. S., Van Lente, F., Nambi, V., Shishehbor, M. H., Aviles, R. J., ... Hazen, S. L. (2003). Prognostic value of myeloperoxidase in patients with chest pain. The New England Journal of Medicine, 349(17), pp. 1595-604.
    Brennan ML, et al. Prognostic Value of Myeloperoxidase in Patients With Chest Pain. N Engl J Med. 2003 Oct 23;349(17):1595-604. PubMed PMID: 14573731.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Prognostic value of myeloperoxidase in patients with chest pain. AU - Brennan,Marie-Luise, AU - Penn,Marc S, AU - Van Lente,Frederick, AU - Nambi,Vijay, AU - Shishehbor,Mehdi H, AU - Aviles,Ronnier J, AU - Goormastic,Marlene, AU - Pepoy,Michael L, AU - McErlean,Ellen S, AU - Topol,Eric J, AU - Nissen,Steven E, AU - Hazen,Stanley L, PY - 2003/10/24/pubmed PY - 2003/10/30/medline PY - 2003/10/24/entrez SP - 1595 EP - 604 JF - The New England journal of medicine JO - N. Engl. J. Med. VL - 349 IS - 17 N2 - BACKGROUND: Inflammation is linked to adverse outcomes in acute coronary syndromes. Myeloperoxidase, an abundant leukocyte enzyme, is elevated in culprit lesions that have fissured or ruptured in patients with sudden death from cardiac causes. Numerous lines of evidence suggest mechanistic links between myeloperoxidase and both inflammation and cardiovascular disease. METHODS: We assessed the value of plasma levels of myeloperoxidase as a predictor of the risk of cardiovascular events in 604 sequential patients presenting to the emergency department with chest pain. RESULTS: Initial plasma myeloperoxidase levels predicted the risk of myocardial infarction, even in patients who are negative for troponin T (<0.1 ng per milliliter) at base line (P<0.001). Myeloperoxidase levels at presentation also predicted the risk of major adverse cardiac events (myocardial infarction, the need for revascularization, or death) within 30 days and 6 months after presentation (P<0.001). In patients without evidence of myocardial necrosis (defined as those who were negative for troponin T), the base-line myeloperoxidase levels independently predicted the risk of major adverse coronary events at 30 days (unadjusted 2nd, 3rd, and 4th quartile odds ratios, 2.2 [95 percent confidence interval, 1.1 to 4.6], 4.2 [95 percent confidence interval, 2.1 to 8.4], and 4.1 [95 percent confidence interval, 2.0 to 8.4], respectively) and at 6 months. CONCLUSIONS: A single initial measurement of plasma myeloperoxidase independently predicts the early risk of myocardial infarction, as well as the risk of major adverse cardiac events in the ensuing 30-day and 6-month periods. Myeloperoxidase levels, in contrast to troponin T, creatine kinase MB isoform, and C-reactive protein levels, identified patients at risk for cardiac events in the absence of myocardial necrosis, highlighting its potential usefulness for risk stratification among patients who present with chest pain. SN - 1533-4406 UR - https://www.unboundmedicine.com/medline/citation/14573731/full_citation L2 - https://www.nejm.org/doi/10.1056/NEJMoa035003?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=www.ncbi.nlm.nih.gov DB - PRIME DP - Unbound Medicine ER -