Myeloperoxidase as a Predictor for Subsequent Cardio-vascular Events in Patients with Acute Myocardial Infarction
AbstractBackground. Inflammation has been linked to all stages of the develop-ment of vulnerable plaque which not only causes platelet activation but also proceeded by activation of polymorphonuclear neutrophils (PMNs). Myeloperoxidase (MPO), a hemoprotein abundantly expressed by PMNs and secreted during activation, possesses potent proinflammatory prop-erties and may contribute directly to tissue injury. Among predictors of major adverse cardiovascular events (MACE) that we have been widely used and known, such as hs-CRP and Troponin T, it still unknown whether MPO also provides prognostic information in patients with acute myocar-dial infarction (AMI).
Objectives. The aim of our study is to search predictive value of MPO and to compare MPO with hs-CRP and Troponin T as a predictor of MACE in patients with AMI.
Methods.Cohort-prospective study was done, conducted from April to June 2006 in the emergency department of National Cardiovascular Cen-tre - Harapan Kita, (NCVC-HK), Jakarta. MPO, hs-CRP, and troponin T serum levels were assessed in 93 patients with AMI. It recorded death, re-infarctions, angina, revascularization, and heart failure during 6 months of follow-up.
Results.Patients with MPO serum level > 204,9 µg/l have increased risk of cardiovascular events (HR 6.76; 95% CI 3.37-13.56, P < 0.001). In statistical analysis, MPO (sensitivity 83.1%; specificity 82.4%) is a stronger independent predictor for subsequent cardiovascular events than Tropo-nin T (sensitivity 59.8%; specificity 71.6%) and hs-CRP (sensitivity 48.5%; specificity 46.1%).
Conclusions.MPO serum levels powerfully predict an increased risk for subsequent cardiovascular events in patients with acute myocardial infarction.
Baldus S, Heeschen C, Meinertz T, Zeiher AM, Eiserich JP, Munszel T, et al. Myeloperoxidase serum levels predict risk in patients with acute coronary syndromes. Circulation. 2003;108:1440-45.
Brennan ML, Penn MS, Van Lente F, Nambi V, Shishehbor MH, Aviles RJ, et al. Prognostic value of myeloperoxidase in patients with chest pain. N Engl J Med 2003;349:1595-1604.
Zhang R, Brennan ML, Fu X, Aviles RJ, Pearce GL, Penn MS, et al. Association between myeloperoxidase levels and risk of coronary artery disease. JAMA.2001;286:2136-42.
Armstrong EJ, Morrow DA, Sabatine MS. Inflamatory biomarkers in acute coronary syndromes. Circulation. 2006;113:e289-e92.
Apple FS, Wu AH, Mair J, Ravkilde J, Panteghini M, Tate J, et al. Future biomarkers for detection of ischemia and risk stratification in acute coronary syndrome. Clinical Chemistry. 2005;51(5):810-24.
Hazen SL. Myeloperoxidase and plaque vulnerability. Arterioscler Thromb Vasc Biol. 2004;24:1143-46.
Takeshita J, Byun J, Nhan TQ, Pritchard DK, Pennathur S, Schwartz SM et al. Myeloperoxidase generates 5-chlorouracil in human atherosclerotic tissue. Journal of Biological Chemistry. 2006;281(6):3096-104.
Vita JA, Brennan ML, Gokce N, Mann SA, Goormastic M, Shishehbor MH, et al. Serum myeloperoxidase levels independently predict endothelial dysfunction in humans. Circulation. 2004;110:1134-39.
Nicholls SJ, Hazen SL. The role of myeloperoxidase in the pathogenesis of coronary artery disease. Jpn.J.Infect.Dis. 2004;57:s21-2.
Winter RJ, Fischer J, Bholasingh R, Straalen JP, Jong T, Tijssen GP et al. C-reactive protein and cardiac troponin T in risk stratification:differences in optimal timing of test early after the onset of chest pain. Clinical Chemistry. 2004;46(10):1597-603.
Naghavi M, Libby P, Falk E, Cascells W, Litovsky S, Rumberger J, et al . From vulnerable plaque to vulnerable patients. Circulation. 2003;108:1664-72.
Purnomo H. Plak vulnerable pada stenosis 50% pembuluh darah koroner: medikamentosa atau intervensi. Dalam: Acute cardiovascular care: improving the outcome. Harimurti GM, Soerianata S, Kaligis RWM, Karo-karo S, Setianto B.editors. Disampaikan pada 17th Weekend course on cardiology. Jakarta, 29 September-1 Oktober 2005.
Zhang C, Yang J, Jacobs JD, Jennings LK. Interaction of myeloperoxidase with vascular NADPH oxidase-derived reactive oxygen species in vasculature: implication for vascular diseases. Am J Physiol Heart Circ Physiol .2003;285:2563-72.
Zhang R, Shen Z, Nauseef WM, Hazen SL. Defects in leukocyte-mediated initiation of lipid peroxidation in plasma as studied in myeloperoxidase deficient subjects: systemic identification of multiple enogenous diffusible substrates for myeloperoxidase in plasma. Blood. 2002;99:1802-10.
Hoy A, Muller BL, Kutter D, Siest G, Visvikis S. Growing significance of myeloperxidase in non infectious disease. Clin Chem Lab Med. 2002;40(1):2-8.
Sugiyama S, Kugiyama K, Aikawa M, Nakamura S, Ogawa H, Libby P. Hypochlorous acid, a macrophage product, induces endothelial apoptosis and tissue factor expression. Arterioscler Thromb Vasc Biol. 2004;24:1309-14.
Zheng L, Nukuna B, Brennan ML, Sun M, Goormastic M, Settle M, et al. Apolipoprotein A-1 is a selective target for myeloperoxidase-catalysed oxidation and functional impairment in subjects with cardiovascular disease. J Clin Invest. 2004;114:529-41.
Vasilyev N, Williams T, Brennan ML, Unzek S, Zhou X, Heinecke JW, et al. Myeloperoxidase-generated oxidants modulate left ventricular remodeling but not infarct size after myocardial infarction. Circulation. 2005;112:2812-20.
Askari AT, Brennan ML, Zhou X, Drinko J, Morehead A, Thomas JD, et al. Myeloperoxidase and Plasminogen Activator Inhibitor-1 play a central role in ventricular remodeling after myocardial infarction. J Exp Med. 2003;197(5):615-24.
Tsimikas S, Willerson JT, Ridker PM. C-Reactive Protein and other emerging blood biomarkers to optimize risk stratification of vulnerable patients. J Am Coll Cardiol 2006;47:C19 –31.
Nadeem SMNA, Kazmi K, Chandna I, Basir N, Pathan A. Prognostic significance of Troponin-T and clinical variables in acute coronary syndrome. JPMA 2003;53(7):280-6.
Stenvinkel P, Ayala ER, Massy ZA, Qureshi AR, Barany P, Fellstrom B et al. Statin treatment and diabetes affect myeloperoxidase in maintenance hemodialysis patient. Clin J Am Soc Nephrol. 2006;1:281-7.
Reynolds WF, Monnink SHJ, Tio RA, Sieburg HB, Veeger NJGM, Boven AJ et al. Gender dependent association of the – 463G/A myeloperoxidase polymorphism with impaired vasodilation in CAD patients. Accessed on July 30, 2006. Available from http://dissertations.ub.rug.nl/FILES/faculties/medicine/2003/s.h.j.monnink/thesis.pdf.
Nikpoor B, Turecki G, Fournier C, Theroux P, Rouleau GA. A functional myeloproxidase polymorphic variant is associated with coronary artery disease in French-Canadians. Am Heart J 2001;142:336-9.
Makela R, Karhunen PJ, Kunnas TA, Ilveskoski E, Kajander OA, Mikkelsson J et al.Myeloperoxidase gene variation as a determinant of atherosclerosis progression in the abdominal and thoracic aorta: an autopsy study. Lab Invest 2003;83:919–25.
Levinson SS, Miller JJ, Elin RJ. Poor predictive value of high-sensitivity C-reactive protein indicates need for reassessment. Clinical Chemistry 2004;50(10):1733-5.
Jones DM, Liu K, Tian L, Greenland P. Narrative review: assessment of hs C-Reactive protein in risk prediction for cardiovascular disease. Ann Intern Med. 2006;145:35-42.
Schnabel R, Rupprecht HJ, Lackner KJ, Lubos E, Bickel C, Meyer J. analysis of N-terminal-pro-brain natriuretic peptide and C-reactive protein for risk stratification in stable and unstable coronary artery disease: results from the atherogene study. Eur Heart J. 2005:26:241-9.
Rifai N, Ridker PM. High-sensitivity C-reactive protein: a novel and promising marker of coronary heart disease. Clinical Chemistry 2001;47(3):403-11.
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