Coronary artery disease
Usefulness of Baseline Plasma Myeloperoxidase Levels as an Independent Predictor of Myocardial Infarction at Two Years in Patients Presenting With Acute Coronary Syndrome

https://doi.org/10.1016/j.amjcard.2006.12.060Get rights and content

Baseline plasma myeloperoxidase (MPO) levels have been shown to independently predict the early risk of myocardial infarction (MI) in patients presenting with chest pain. In addition, baseline MPO levels have been demonstrated to predict the development of adverse cardiac events up to 6 months after an acute coronary syndrome (ACS). However, in contrast to other biomarkers, there are no data about the long-term independent predictive value of baseline MPO values in patients with ACS. The present study investigated the long-term prognostic significance of baseline MPO levels in a well-characterized cohort of 193 men with ACS who were referred for coronary angiography at a Veterans Administration Medical Center. All patients were followed prospectively for the development of death and MI, and follow-up data were available for all patients at 24 months. After controlling for different baseline clinical, laboratory, and angiographic variables, baseline plasma MPO values were a strong and independent predictor of MI at 24 months by multivariate analysis. Using the median MPO value of the entire cohort of patients (i.e., 20.34 ng/ml) as a prespecified cutoff, the MI-free survival at 24 months for the group whose baseline MPO values were ≤20.34 ng/ml was 88% compared with 74% in those whose values were >20.34 ng/ml (p = 0.0249 by log-rank test). In conclusion, these data demonstrate that baseline MPO levels independently predict MI at 2 years in patients with ACS.

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Methods

This study was conducted at a Veterans Administration Medical Center and was approved by the local institutional review board. Written informed consent was obtained from all patients. Between January 1999 and October 2002, 193 men who underwent diagnostic coronary angiography for evaluation of ACS were enrolled in the study. Patients with active gastrointestinal bleeding were excluded from the study. Three groups of patients were categorized by type of ACS4: (1) the group with ST-elevation

Results

In total, 193 men were enrolled in the study. MPO values were available for 182 of these patients. Baseline clinical and laboratory characteristics of the study population stratified by the median MPO value for the cohort are listed in Table 1. The breakdown of the patient population based on the primary indication for coronary angiography was as follows: ST-segment elevation MI in 23 patients (12%), non–ST-segment elevation MI in 84 patients (43%), and troponin-negative unstable angina in 86

Discussion

In a broad cohort of patients with ACS, we found a strong and statistically significant independent association between increased baseline levels of MPO and subsequent development of MI in the ensuing 24 months. Although there are compelling data relating increased baseline MPO levels to poor short-term prognosis in ACS, similar data for long-term outcomes are lacking. This is in contrast to other inflammatory biomarkers, such as hs-CRP, which have been shown to be predictive of short- and

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