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Yiu JYT, Hally KE, Larsen PD, Holley AS. Neutrophil-Enriched Biomarkers and Long-Term Prognosis in Acute Coronary Syndrome: a Systematic Review and Meta-analysis. J Cardiovasc Transl Res 2024; 17:426-447. [PMID: 37594719 PMCID: PMC11052791 DOI: 10.1007/s12265-023-10425-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 08/02/2023] [Indexed: 08/19/2023]
Abstract
Activated neutrophils release a range of inflammatory products that represent potential biomarkers, and there is interest in the prognostic value of these in acute coronary syndrome (ACS) patients. We conducted a systematic review to examine neutrophil-enriched biomarkers and the occurrence of major adverse cardiovascular events (MACE) in patients with ACS. We identified twenty-seven studies including 17,831 patients with ACS. The most studied biomarkers were neutrophil gelatinase-associated lipocalin (NGAL) and myeloperoxidase (MPO). Meta-analyses showed that elevated NGAL was associated with higher MACE rates (unadjusted risk ratio (RR) 1.52, 95% CI 1.12-2.06, p = 0.006) as were elevated MPO levels (unadjusted RR 1.61, 95% CI 1.22-2.13, p = 0.01). There was limited data suggesting that increased levels of calprotectin, proteinase-3 and double-stranded DNA were also associated with MACE. These results suggest that higher levels of neutrophil-enriched biomarkers may be predictive of MACE in patients with ACS, although higher-quality studies are needed to confirm these observations.
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Affiliation(s)
- Jaquelina Y T Yiu
- Wellington Cardiovascular Research Group, Department of Surgery & Anaesthesia, University of Otago, PO Box 7343, Wellington, New Zealand
| | - Kathryn E Hally
- Wellington Cardiovascular Research Group, Department of Surgery & Anaesthesia, University of Otago, PO Box 7343, Wellington, New Zealand
| | - Peter D Larsen
- Wellington Cardiovascular Research Group, Department of Surgery & Anaesthesia, University of Otago, PO Box 7343, Wellington, New Zealand
| | - Ana S Holley
- Wellington Cardiovascular Research Group, Department of Surgery & Anaesthesia, University of Otago, PO Box 7343, Wellington, New Zealand.
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Li J, Chen R, Zhou J, Wang Y, Zhao X, Liu C, Zhou P, Chen Y, Song L, Yan S, Yan H, Zhao H. Prognostic Value of Admission Peak NT-proBNP Combined with Culprit Plaque Types for Predicting Cardiovascular Risk in ST-Segment Elevated Myocardial Infarction: An Optical Coherence Tomography Study. J Cardiovasc Dev Dis 2022; 9:jcdd9120466. [PMID: 36547463 PMCID: PMC9786275 DOI: 10.3390/jcdd9120466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 11/29/2022] [Accepted: 12/16/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE Different culprit plaque phenotypes including plaque rupture (PR) and non-plaque rupture (NPR), and N-Terminal prohormone of brain natriuretic peptide (NT-proBNP) have been reported to influence clinical outcomes in patients with acute coronary syndrome (ACS). We aimed to investigate the prognostic implication of the peak and baseline values at admission for NT-proBNP for major adverse cardiovascular events (MACE) in ST-Segment Elevated Myocardial Infarction (STEMI) patients with different plaque phenotype. METHODS A total of 428 patients with STEMI undergoing optical coherence tomography (OCT) were enrolled and divided into four groups: PR/Tertile1-2 NT-proBNP (n = 132), PR/Tertile3 NT-proBNP (n = 65), NPR/Tertile1-2 NT-proBNP (n = 154), NPR/Tertlie3 NT-proBNP (n = 77). Baseline and Peak values of NT-proBNP were obtained in the admission period. The MACEs were defined as the composite of all-cause death, recurrence of myocardial infarction and stroke. RESULTS High levels for peak NT-proBNP were significantly associated with a higher incidence of MACE and death (Log rank p = 0.037 and 0.0012, respectively). In the subgroup with NPR, a high level for peak NT-proBNP was significantly associated with higher incidence of death (Log rank p = 0.0022) but this association was not significant in the subgroup of PR (Log rank p = 0.24). Though plaque types were not associated with adverse event, the combination of NPR and a higher peak value for NT-proBNP indicated higher incidence of death compared with other groups (Log rank p = 0.0017). The area under the receiver operating characteristic curve for predicting death to evaluate the diagnostic value of the peak value for NT-proBNP and plaque types combined with traditional risk factors was 0.843 (95% CI: 0.805-0.876), which is superior to solely traditional risk factors: NRI (26.8% [95% CI: 0.4-53.1%], p = 0.046) and IDI (5.1% [95% CI: 1.0-9.2%], p = 0.016). CONCLUSION STEMI patients with NPR and a high level for peak NT-proBNP showed higher incidence of death. The peak value of NT-proBNP in combination with plaque types can be used in risk stratification and prediction of death in patients with STEMI.
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Affiliation(s)
- Jiannan Li
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100037, China
- Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen 518057, China
| | - Runzhen Chen
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100037, China
| | - Jinying Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100037, China
| | - Ying Wang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100037, China
| | - Xiaoxiao Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100037, China
| | - Chen Liu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100037, China
- Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen 518057, China
| | - Peng Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100037, China
| | - Yi Chen
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100037, China
| | - Li Song
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100037, China
- Coronary Heart Disease Center, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing 100037, China
| | - Shaodi Yan
- Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen 518057, China
| | - Hongbing Yan
- Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen 518057, China
- Coronary Heart Disease Center, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing 100037, China
- Correspondence: (H.Y.); (H.Z.)
| | - Hanjun Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100037, China
- Coronary Heart Disease Center, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing 100037, China
- Correspondence: (H.Y.); (H.Z.)
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Shen S, Ye J, Wu X, Li X. Association of N-terminal pro-brain natriuretic peptide level with adverse outcomes in patients with acute myocardial infarction: A meta-analysis. Heart Lung 2021; 50:863-869. [PMID: 34340134 DOI: 10.1016/j.hrtlng.2021.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/19/2021] [Accepted: 07/06/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Studies evaluating the association of blood level of N-terminal pro-brain natriuretic peptide (NT-proBNP) with adverse prognosis have yielded conflicting results in patients with acute myocardial infarction (AMI). This meta-analysis sought to evaluate the prognostic value of blood level of NT-proBNP in patients with AMI. METHODS Two authors independently searched articles in PubMed and Embase databases up to June 13, 2021. Studies evaluating the association of baseline NT-proBNP level with all-cause mortality or major adverse cardiovascular events (MACEs, including death, new or worsening heart failure, recurrent myocardial infarction, revascularization, stroke, etc.) among AMI patients were selected. Multivariable-adjusted risk ratio (RR) with 95% confidence interval (CI) was pooled by the highest vs. lowest category of NT-proBNP level. RESULTS A total of 19 studies enrolling 12,158 AMI patients were identified. When compared highest with the lowest category of NT-proBNP level, the pooled RR was 5.28 (95% CI 2.87-9.73) for in-hospital/30-day death, 2.62 (95% CI 2.04-3.37) for follow-up all-cause mortality, and 2.50 (95% CI 1.91-3.28) for follow-up MACEs, respectively. Subgroup analysis further confirmed the value of NT-proBNP in predicting all-cause mortality and MACEs. CONCLUSIONS Elevated NT-proBNP level is independently associated with an increased risk of all-cause mortality and MACEs. Determination of blood NT-proBNP level can improve risk stratification of AMI patients.
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Affiliation(s)
- Shenghui Shen
- Department of Cardiology, Tongde Hospital of Zhejiang Province, Hangzhou City, Zhejiang Province, 310012, PR China
| | - Jianhua Ye
- Department of Cardiology, Tongde Hospital of Zhejiang Province, Hangzhou City, Zhejiang Province, 310012, PR China
| | - Xiangzhong Wu
- Department of Intensive Medicine, Tongde Hospital of Zhejiang Province, Hangzhou City, Zhejiang Province, 310012, PR China
| | - Xiaoling Li
- Department of Cardiology, Tongde Hospital of Zhejiang Province, Hangzhou City, Zhejiang Province, 310012, PR China.
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Prognostic Role of Elevated Myeloperoxidase in Patients with Acute Coronary Syndrome: A Systemic Review and Meta-Analysis. Mediators Inflamm 2019; 2019:2872607. [PMID: 31341419 PMCID: PMC6614978 DOI: 10.1155/2019/2872607] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 01/11/2019] [Accepted: 06/09/2019] [Indexed: 01/07/2023] Open
Abstract
Background Myocardial inflammation following acute ischemic injury has been linked to poor cardiac remodeling and heart failure. Many studies have linked myeloperoxidase (MPO), a neutrophil and inflammatory marker, to cardiac inflammation in the setting of acute coronary syndrome (ACS). However, the prognostic role of MPO for adverse clinical outcomes in ACS patients has not been well established. Methods MEDLINE and Cochrane databases were searched for studies from 1975 to March 2018 that investigated the prognostic value of serum MPO in ACS patients. Studies which have dichotomized patients into a high MPO group and a low MPO group reported clinical outcomes accordingly and followed up patients for at least 30 days to be eligible for enrollment. Data were analyzed using random-effects model. Sensitivity analyses were conducted for quality control. Results Our meta-analysis included 13 studies with 9090 subjects and a median follow-up of 11.4 months. High MPO level significantly predicted mortality (odds ratio (OR) 2.03; 95% confidence interval (CI): 1.40-2.94; P < 0.001), whereas it was not significantly predictive of major adverse cardiac events and recurrent myocardial infarction (MI) (OR 1.28; CI: 0.92-1.77, P = 0.14 and OR 1.23; CI: 0.96-1.58, P = 0.101, respectively). Hypertension, diabetes mellitus, and age did not affect the prognostic value of MPO for clinical outcomes, whereas female gender and smoking status have a strong influence on the prognostic value of MPO in terms of mortality and recurrent MI (metaregression coefficient -8.616: 95% CI -14.59 to -2.633, P = 0.0048 and 4.88: 95% CI 0.756 to 9.0133, P = 0.0204, respectively). Conclusions Our meta-analysis suggests that high MPO levels are associated with the risk of mortality and that MPO can be incorporated in risk stratification models that guide therapy of high-risk ACS patients.
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Zeljković I, Manola Š, Radeljić V, Delić Brkljačić D, Babacanli A, Pavlović N. ROUTINELY AVAILABLE BIOMARKERS AS LONG-TERM PREDICTORS OF DEVELOPING SYSTOLIC DYSFUNCTION IN COMPLETELY REVASCULARIZED PATIENTS WITH ACUTE ST ELEVATION MYOCARDIAL INFARCTION. Acta Clin Croat 2019; 58:95-102. [PMID: 31363330 PMCID: PMC6629206 DOI: 10.20471/acc.2019.58.01.12] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The aim of this study was to assess the efficacy of high-sensitivity C-reactive protein (hsCRP), cardiac troponin T (cTnT) and creatine kinase (CK) as long-term predictors of reduced systolic function in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) with complete revascularization. This prospective study evaluated consecutive patients with acute STEMI who had normal left ventricular ejection fraction (LVEF ≥50%) at admission with single-vessel disease and underwent complete revascularization. Blood samples were collected from admission to day 7. The primary endpoint was reduction of LVEF <50% after 12 months. The study included 47 patients, median age 59±10 years, 74.5% of them men. Patients who developed systolic dysfunction (LVEF <50%) had significantly higher mean values of cTnT after 24 hours (5.11 vs. 2.82 µg/L, p=0.010) and peak values of CK (3375.5 vs. 1865 U/L, p=0.008). There was no significant relation between hsCRP and development of reduced LVEF (p=0.541). In conclusion, cTnT and CK could serve as long-term predictors of reduced left ventricular systolic function (<50%) in acute STEMI patients with normal systolic function at admission, single-vessel coronary disease and complete revascularization during primary PCI.
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Affiliation(s)
| | - Šime Manola
- 1Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Emergency Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Vjekoslav Radeljić
- 1Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Emergency Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Diana Delić Brkljačić
- 1Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Emergency Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Alen Babacanli
- 1Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Emergency Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Nikola Pavlović
- 1Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Emergency Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
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Kacprzak M, Zielinska M. Prognostic value of myeloperoxidase concentration in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention. Int J Cardiol 2016; 223:452-457. [PMID: 27544604 DOI: 10.1016/j.ijcard.2016.07.258] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 07/08/2016] [Accepted: 07/30/2016] [Indexed: 11/19/2022]
Abstract
Inflammation plays an important role on every stage of atherosclerosis. Myeloperoxidase (MPO), a leukocyte-derived enzyme that participates in the innate immunity, probably is involved in many stages of atherothrombosis. According to the recent studies, MPO is related with unfavorable outcome in patients with chest pain and acute coronary syndromes. Its role in prediction of outcomes after ST-segment elevation myocardial infarction (STEMI) remains unclear. The aim of the study was to assess if elevated MPO level is a predictor of long-term adverse cardiac events in patients with STEMI treated with primary percutaneous coronary intervention (pPCI). MATERIAL AND METHODS We evaluated data of 127 patients with STEMI. Plasma levels of MPO collected on admission and the 3rd-4th day of hospitalization were measured by ELISA method. C-reactive protein (CRP) and N-terminal prohormone of B-type natriuretic peptide (NT-proBNP) were also determined. All patients were followed-up prospectively for the occurrence of major adverse cardiovascular events (MACE) defined as unscheduled coronary revascularization procedure, stroke, reinfarction or all-cause death. RESULTS After 14months of follow-up 20% of patients developed MACE. Elevated MPO levels collected on the 3rd-4th day of STEMI were the predictor of death, reinfarction, the need for coronary revascularization and all adverse events taken together. In multivariate analysis, MPO and CRP levels assessed on the 3rd-4th day of hospitalization revealed to be significant predictors of MACE. MPO demonstrated to be significantly better predictor of MACE than NT-proBNP level. CONCLUSIONS Myeloperoxidase is a prognostic marker in patients with STEMI treated with pPCI.
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Affiliation(s)
- Michal Kacprzak
- Intensive Cardiac Therapy Clinic, Medical University of Lodz, Poland.
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Li X, Kramer MC, Damman P, van der Wal AC, Grundeken MJ, van Straalen JP, Koch KT, Henriques JP, Baan J, Vis MM, Piek JJ, Fischer JC, Tijssen JGP, de Winter RJ. Older coronary thrombus is an independent predictor of 1-year mortality in acute myocardial infarction. Eur J Clin Invest 2016; 46:501-10. [PMID: 26988709 DOI: 10.1111/eci.12619] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 03/09/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND We have previously shown that older thrombus is associated with a twofold higher long-term mortality in ST-segment elevation myocardial infarction (STEMI) patients after primary percutaneous coronary intervention (pPCI). We evaluated whether the addition of the presence of older thrombus to a multimarker model would result in increased predictive power for 1-year mortality in STEMI patients. METHODS The study population (n = 1442) consists of STEMI patients treated with thrombus aspiration during pPCI. Patients were included if aspirated thrombus material could histopathologically be classified according to thrombus age (n = 870) and laboratory measurements of biomarkers (cardiac troponin T, glucose, N-terminal pro-brain natriuretic peptide, estimated glomerular filtration rate and C-reactive protein) were available. The additional prognostic value of the presence of older thrombus beyond multiple biomarkers and established clinical risk factors was evaluated using multivariate Cox regression models. RESULTS Serum biomarker concentrations were similar between patients with fresh and older thrombus. Sixty patients (7%) died within 1 year. The presence of older thrombus remained strongly associated with mortality at 1 year after multivariable adjustment for multiple biomarkers and established clinical risk factors. Addition of older thrombus to either a model including clinical risk factors and biomarkers or a model including solely biomarkers resulted in significant increases in the discriminative value, evidenced by net reclassification improvement and integrated discriminative improvement. CONCLUSIONS The presence of older thrombus provides independent complementary information to a multimarker model including established clinical risk factors and multiple biomarkers for predicting 1-year mortality in STEMI patients treated with pPCI and thrombus aspiration.
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Affiliation(s)
- Xiaofei Li
- Department of Medical Sciences, Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Miranda C Kramer
- Department of Medical Sciences, Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Peter Damman
- Department of Medical Sciences, Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Allard C van der Wal
- Department of Medical Sciences, Clinical Chemistry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Maik J Grundeken
- Department of Medical Sciences, Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Jan P van Straalen
- Departments of Medical Sciences, Pathology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Karel T Koch
- Department of Medical Sciences, Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Jose P Henriques
- Department of Medical Sciences, Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Jan Baan
- Department of Medical Sciences, Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Marije M Vis
- Department of Medical Sciences, Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Jan J Piek
- Department of Medical Sciences, Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Johan C Fischer
- Departments of Medical Sciences, Pathology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Jan G P Tijssen
- Department of Medical Sciences, Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Robbert J de Winter
- Department of Medical Sciences, Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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Jespersen CHB, Vestergaard KR, Schou M, Teisner B, Goetze JP, Iversen K. Pregnancy-associated plasma protein-A and the vulnerable plaque. Biomark Med 2015; 8:1033-47. [PMID: 25343675 DOI: 10.2217/bmm.14.53] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
For more than a decade, pregnancy-associated plasma protein-A (PAPP-A) has been examined for its relation to acute coronary syndrome (ACS) and the vulnerable plaque. This review summarizes the current knowledge of plasma PAPP-A in relation to nonpregnant individuals focusing on patients with ACS, discusses its use as a possible biomarker for diagnosis and prognosis in ACS, briefly describes the challenges in different assay technologies and describes the effect of heparin administration on PAPP-A concentrations in plasma.
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Li Y, Zhou C, Zhou X, Li L, Hui R. Pregnancy-associated plasma protein A predicts adverse vascular events in patients with coronary heart disease: a systematic review and meta-analysis. Arch Med Sci 2013; 9:389-97. [PMID: 23847657 PMCID: PMC3701985 DOI: 10.5114/aoms.2013.35421] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 03/29/2013] [Accepted: 04/19/2013] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Prospective studies about the association between elevated circulating pregnancy-associated plasma protein A (PAPP-A) and adverse vascular events in patients with coronary heart diseases (CHD) are inconsistent. We performed a meta-analysis to clarify this issue. MATERIAL AND METHODS We identified prospective studies by searching MEDLINE. The vascular outcomes included all-cause mortality, combination of all-cause mortality and non-fatal myocardial infarction (MI), and combined cardiovascular events. Prospective studies providing multivariable adjusted relative risks (RRs) and their 95% confidence intervals (CIs) of pre-mentioned outcomes were included. A random-effects model was used to calculate the pooled RRs. Subgroup and sensitivity analyses were used to explore the potential sources of heterogeneity or modifiable factors. RESULTS Fourteen studies with a total of 12 830 participants were included. Elevated PAPP-A level was associated with all-cause mortality (pooled RR 1.74, 95% CI: 1.45 to 2.09, p < 0.001), combined all-cause mortality and non-fatal MI (RR 1.59, 95% CI: 1.37 to 1.85, p < 0.001) and combined cardiovascular events (RR 1.50, 95% CI: 1.22 to 1.85, p < 0.001). There was no significant heterogeneity. Subgroup and sensitivity analyses showed that the positive association was not affected by follow-up term, CHD type, different assay methods of PAPP-A, or studies with less than 5 adjusted variables. CONCLUSIONS Elevated serum PAPP-A level is associated with adverse vascular outcomes in patients with CHD.
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Affiliation(s)
- Yuehua Li
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China ; Hypertension Division, Fuwai Hospital, National Center for Cardiovascular Diseases, Beijing, China ; Sino-German Laboratory for Molecular Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Beijing, China
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Nussbaum C, Klinke A, Adam M, Baldus S, Sperandio M. Myeloperoxidase: a leukocyte-derived protagonist of inflammation and cardiovascular disease. Antioxid Redox Signal 2013; 18:692-713. [PMID: 22823200 DOI: 10.1089/ars.2012.4783] [Citation(s) in RCA: 144] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
SIGNIFICANCE The heme-enzyme myeloperoxidase (MPO) is one of the major neutrophil bactericidal proteins and is stored in large amounts inside azurophilic granules of neutrophils. Upon cell activation, MPO is released and extracellular MPO has been detected in a wide range of acute and chronic inflammatory conditions. Recent ADVANCES AND CRITICAL ISSUES: Apart from its role during infection, MPO has emerged as a critical modulator of inflammation throughout the last decade and is currently discussed in the initiation and propagation of cardiovascular diseases. MPO-derived oxidants (e.g., hypochlorous acid) interfere with various cell functions and contribute to tissue injury. Recent data also suggest that MPO itself exerts proinflammatory properties independent of its catalytic activity. Despite advances in unraveling the complex action of MPO and MPO-derived oxidants, further research is warranted to determine the precise nature and biological role of MPO in inflammation. FUTURE DIRECTIONS The identification of MPO as a central player in inflammation renders this enzyme an attractive prognostic biomarker and a potential target for therapeutic interventions. A better understanding of the (patho-) physiology of MPO is essential for the development of successful treatment strategies in acute and chronic inflammatory diseases.
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Affiliation(s)
- Claudia Nussbaum
- Walter Brendel Centre for Experimental Medicine, Ludwig-Maximilians-University Munich, Munich, Germany.
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Mjelva ØR, Brügger-Andersen T, Pönitz V, Grundt H, Kontny F, Staines H, Nilsen DW. Long-term prognostic utility of PAPP-A and calprotectin in suspected acute coronary syndrome. SCAND CARDIOVASC J 2013; 47:88-97. [DOI: 10.3109/14017431.2013.764571] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
| | | | - Volker Pönitz
- Department of Cardiology, Stavanger University Hospital,
Stavanger, Norway
| | - Heidi Grundt
- Department of Medicine, Stavanger University Hospital,
Stavanger, Norway
- Institute of Medicine, University of Bergen,
Bergen, Norway
| | | | | | - Dennis W.T. Nilsen
- Department of Cardiology, Stavanger University Hospital,
Stavanger, Norway
- Institute of Medicine, University of Bergen,
Bergen, Norway
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Kamanna VS, Ganji SH, Kashyap ML. Myeloperoxidase and Atherosclerosis. CURRENT CARDIOVASCULAR RISK REPORTS 2013. [DOI: 10.1007/s12170-013-0291-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Sánchez M, Llorens P, Herrero P, Martín-Sanchez FJ, Piñera P, Miró Ò. The utility of copeptin in the emergency department as a predictor of adverse outcomes in non-ST-elevation acute coronary syndrome: the COPED-PAO study. Emerg Med J 2013; 31:286-91. [PMID: 23371977 DOI: 10.1136/emermed-2012-201996] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS To test the utility of a single copeptin determination at presentation to the emergency department (ED) as a short-term prognosis marker in patients with non-ST-elevation acute coronary syndrome (NSTEACS). To compare the results with those achieved with conventional troponin. METHODS A multicentric, prospective, observational, longitudinal, cohort study involving 15 Spanish EDs. Inclusion: consecutive patients with chest pain (<12 h) finally diagnosed of NSTEACS. MEASUREMENTS copeptin and troponin at arrival. Cut-off point for copeptin: 25.9 pmol/l. FOLLOW-UP within 2 months after ED attendance to identify 30-day adverse events. Discriminatory capacity of copeptin and troponin was compared by receiver operating characteristic (ROC) curves. RESULTS We included 377 patients with NSTEACS. Adverse events: 11 (2.9%) patients died, 27 (7.2%) had an adverse coronary event, 14 (3.7%) had a stroke, and 48 (12.7%) a composite endpoint. The initial copeptine value was over 25.9 pmol/l in 114 patients, and they presented a higher mortality rate (OR: 4.2, (95% CI 1.2 to 14.8); p=0.03). This association disappeared after adjusting by clinical variables or troponin level. No significant differences were found for the remaining endpoints. The area under the curve of the ROC curve of 30-day mortality was 0.73 (95% CI 0.58 to 0.87) for copeptin, and 0.80 (95% CI 0.73 to 0.87) for troponin. CONCLUSIONS In patients with NSTEACS, determination of copeptin at presentation to the ED is associated with risk of death during the subsequent month. This association, however, disappears after adjusting by baseline features or troponin level, so copeptin does not add complementary prognostic information over that provided by troponin.
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Affiliation(s)
- Miquel Sánchez
- Emergency Department, Àrea d'Urgències, Hospital Clínic de Barcelona, Grupo de Investigación 'Urgencias: procesos y patologias', IDIBAPS, , Barcelona, Catalonia, Spain
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Li Y, Zhou C, Zhou X, Song L, Hui R. PAPP-A in cardiac and non-cardiac conditions. Clin Chim Acta 2012; 417:67-72. [PMID: 23262366 DOI: 10.1016/j.cca.2012.12.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Revised: 12/06/2012] [Accepted: 12/09/2012] [Indexed: 12/30/2022]
Abstract
Pregnancy-associated plasma protein-A (PAPP-A), a newly discovered member of insulin like growth factors (IGFs) axis, has been reported to be a biomarker in both cardiac and non-cardiac conditions. PAPP-A mainly acts as a protease cleaving IGF inhibitors - IGF binding proteins (IGFBPs), thereby setting free IGFs. In cardiac conditions, PAPP-A plays an important role in progressive atherosclerosis. As a biomarker, PAPP-A is not only sensitive, specific and early for diagnosis of acute coronary syndrome, but also an independent risk factor for all-cause mortality or combined cardiovascular events. In non-cardiac conditions, PAPP-A is a new anti-aging target. PAPP-A knock out (KO) mice have a prolonged lifespan than the wild type. In addition, PAPP-A is also a biomarker associated with malignant cancer and end stage renal disease.
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Affiliation(s)
- Yuehua Li
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
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Mid-regional pro-atrial natriuretic peptide as a prognostic marker for all-cause mortality in patients with symptomatic coronary artery disease. Clin Sci (Lond) 2012; 123:601-10. [PMID: 22690794 DOI: 10.1042/cs20120216] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
In the present study, we investigated the prognostic value of MR-proANP (mid-regional pro-atrial natriuretic peptide). We consecutively evaluated a catheterization laboratory cohort of 2700 patients with symptomatic CAD (coronary artery disease) [74.1% male; ACS (acute coronary syndrome), n=1316; SAP (stable angina pectoris), n=1384] presenting to the Cardiology Department of a large primary care hospital, all of whom underwent coronary angiography. Serum MR-proANP and other laboratory markers were sampled at the time of presentation or in the catheterization laboratory. Clinical outcome was assessed by hospital chart analysis and telephone interviews. The primary end point was all-cause death at 3 months after enrolment. Follow-up data were complete in 2621 patients (97.1%). Using ROC (receiver operating characteristic) curves, the AUC (area under the curve) of 0.73 [95% CI (confidence interval), 0.67-0.79] for MR-proANP was significantly higher compared with 0.58 (95% CI, 0.55-0.62) for Tn-I (troponin-I; DeLong test, P=0.0024). According to ROC analysis, the optimal cut-off value of MR-proANP was at 236 pmol/l for all-cause death, which helped to find a significantly increased rate of all-cause death (n=76) at 3 months in patients with elevated baseline concentrations (≥236 pmol/l) compared with patients with a lower concentration level in Kaplan-Meier survival analysis (log rank, P<0.001). The predictive performance of MR-proANP was independent of other clinical variables or cardiovascular risk factors, and superior to that of Tn-I or other cardiac biomarkers (all: P<0.0001). MR-proANP may help in the prediction of all-cause death in patients with symptomatic CAD. Further studies should verify its prognostic value and confirm the appropriate cut-off value.
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Battistoni A, Rubattu S, Volpe M. Circulating biomarkers with preventive, diagnostic and prognostic implications in cardiovascular diseases. Int J Cardiol 2012; 157:160-8. [DOI: 10.1016/j.ijcard.2011.06.066] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Revised: 04/27/2011] [Accepted: 06/12/2011] [Indexed: 12/22/2022]
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Aldous SJ. Cardiac biomarkers in acute myocardial infarction. Int J Cardiol 2012; 164:282-94. [PMID: 22341694 DOI: 10.1016/j.ijcard.2012.01.081] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Revised: 12/16/2011] [Accepted: 01/26/2012] [Indexed: 01/11/2023]
Abstract
Each year, a large number of patients are seen in the Emergency Department with presentations necessitating investigation for possible acute myocardial infarction. Patients can be stratified by symptoms, risk factors and electrocardiogram results but cardiac biomarkers also have a prime role both diagnostically and prognostically. This review summarizes both the history of cardiac biomarkers as well as currently available (established and novel) assays. Cardiac troponin, our current "gold standard" biomarker criterion for the diagnosis of myocardial infarction has high sensitivity and specificity for this diagnosis and therapies instituted in patients with elevated troponin have been shown to influence outcomes. Other markers of myocardial necrosis, inflammation and neurohormonal activity have also been shown to have either diagnostic or prognostic utility, but none have been shown to be superior to troponin. The measurement of multiple biomarkers and the use of point of care markers may accelerate current diagnostic protocols for the assessment of such patients.
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von Haehling S, Papassotiriou J, Morgenthaler NG, Hartmann O, Doehner W, Stellos K, Wurster T, Schuster A, Nagel E, Gawaz M, Bigalke B. Copeptin as a prognostic factor for major adverse cardiovascular events in patients with coronary artery disease. Int J Cardiol 2012; 162:27-32. [PMID: 22284271 DOI: 10.1016/j.ijcard.2011.12.105] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Accepted: 12/21/2011] [Indexed: 12/22/2022]
Abstract
BACKGROUND C-terminal portion of provasopressin (copeptin) has recently been discussed as a novel biomarker for the early rule-out of acute myocardial infarction (AMI). The aim is to investigate the prognostic value of copeptin with regard to mortality and morbidity in patients with symptomatic coronary artery disease (CAD). METHODS We consecutively recruited a cath lab cohort of 2,700 patients (74.1% male; AMI, n=1316; stable angina pectoris, n=1384) presenting to the emergency department of a large primary care hospital. All patients received coronary angiography. Copeptin and other laboratory markers were sampled at the time of presentation or in the cath lab. Clinical outcomes were assessed by hospital chart analysis and telephone interviews. 2621 patients (97.1%) have been successfully followed-up at three months. The primary endpoint was a combined endpoint of rehospitalization for cardiovascular events, stroke, and all-cause death. RESULTS Using receiver operating characteristic curves, we calculated areas under the curve of 0.703 (95%confidence interval(CI):0.681-0.725) for the composite endpoint after three months (myocardial reinfarction, stroke, all-cause death;n=183), and 0.770 (95%CI:0.736-0.803) for all-cause death (n=76) for copeptin. A cutoff value of 21.6 pmol/L for the composite endpoint yielded a sensitivity of 56.3% and a specificity of 78.6%. The predictive performance of copeptin was independent of other clinical variables or cardiovascular risk factors, and superior to that of troponin I or other cardiac biomarkers (all:P<0.0001). CONCLUSIONS Copeptin may help in the prediction of major adverse cardiovascular events in patients with symptomatic CAD. Further studies should substantiate the findings and support the suggested cutoff value of the present study.
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Affiliation(s)
- Stephan von Haehling
- Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany.
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Affiliation(s)
- Bertil Lindahl
- Department of Medical Sciences
- Department of Cardiology, and
- Uppsala Clinical Research Center, University of Uppsala, Uppsala, Sweden
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Manhenke C, Ørn S, von Haehling S, Wollert KC, Ueland T, Aukrust P, Voors AA, Squire I, Zannad F, Anker SD, Dickstein K. Clustering of 37 circulating biomarkers by exploratory factor analysis in patients following complicated acute myocardial infarction. Int J Cardiol 2011; 166:729-35. [PMID: 22197217 DOI: 10.1016/j.ijcard.2011.11.089] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2011] [Revised: 09/30/2011] [Accepted: 11/27/2011] [Indexed: 11/18/2022]
Abstract
BACKGROUND The objective of this study was to elucidate the complex interactions between families of circulating biomarkers representing different biochemical responses to the pathophysiology following complicated acute myocardial infarction (AMI). METHODS Blood samples, drawn at a median of 3 days post AMI were obtained from 236 patients with complicated AMI and evidence of heart failure or left ventricular dysfunction. Using exploratory factor analysis, 37 biomarkers were grouped according to their collinearity to each other into clusters. The clusters were used as a model to elucidate interdependencies between individual biomarkers. Each cluster defines a specific pathophysiological process, called factor. These factors were used as covariates in multivariable Cox-proportional hazard regression analyses for prediction of all-cause death and the combined endpoint of cardiovascular death and re-infarction. RESULTS Exploratory factor analysis grouped the biomarkers under 5 factors. The composition of these groups was partially unexpected but biological plausible. In multivariable analysis, only 1 factor proved to be an independent predictor of outcome. Major contributions (factor loadings>0.50) in this cluster came from: mid-regional pro-adrenomedullin, tumor necrosis factor receptor, pro-endothelin-1, growth differentiation factor 15, C-terminal pro arginine vasopressin, uric acid, chromogranin A and procollagen type III N-terminal. CONCLUSION Clustering of multiple biomarkers by exploratory factor analysis might prove useful in exploring the biological interactions between different biomarkers in cardiovascular disease and thus increase our understanding of the complicated orchestral interplay at the molecular level.
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Myeloperoxidase as a biomarker in acute coronary syndrome: beware of the pitfalls. Arch Med Res 2011; 42:641. [PMID: 22000979 DOI: 10.1016/j.arcmed.2011.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Accepted: 09/28/2011] [Indexed: 11/23/2022]
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Long-term Prognostic Value of Myeloperoxidase on Acute Coronary Syndrome: A Meta-analysis. Arch Med Res 2011; 42:368-74. [DOI: 10.1016/j.arcmed.2011.07.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Accepted: 07/06/2011] [Indexed: 11/18/2022]
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Damman P, Beijk MAM, Kuijt WJ, Verouden NJW, van Geloven N, Henriques JPS, Baan J, Vis MM, Meuwissen M, van Straalen JP, Fischer J, Koch KT, Piek JJ, Tijssen JGP, de Winter RJ. Multiple biomarkers at admission significantly improve the prediction of mortality in patients undergoing primary percutaneous coronary intervention for acute ST-segment elevation myocardial infarction. J Am Coll Cardiol 2011; 57:29-36. [PMID: 21185497 DOI: 10.1016/j.jacc.2010.06.053] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2010] [Revised: 05/20/2010] [Accepted: 06/21/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVES We investigated whether multiple biomarkers improve prognostication in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention. BACKGROUND Few data exist on the prognostic value of combined biomarkers. METHODS We used data from 1,034 STEMI patients undergoing primary percutaneous coronary intervention in a high-volume percutaneous coronary intervention center in the Netherlands and investigated whether combining N-terminal pro-brain natriuretic peptide, glucose, C-reactive protein, estimated glomerular filtration rate, and cardiac troponin T improved the prediction of mortality. A risk score was developed based on the strongest predicting biomarkers in multivariate Cox regression. The additional prognostic value of the strongest predicting biomarkers to the established prognostic factors (age, body weight, diabetes, hypertension, systolic blood pressure, heart rate, anterior myocardial infarction, and time to treatment) was assessed in multivariable Cox regression. RESULTS During follow-up (median, 901 days), 120 of the 1,034 patients died. In Cox regression, glucose, estimated glomerular filtration rate, and N-terminal pro-brain natriuretic peptide were the strongest predictors for mortality (p < 0.05, for all). A risk score incorporating these biomarkers identified a high-risk STEMI subgroup with a significantly higher mortality when compared with an intermediate- or low-risk subgroup (p < 0.001). Addition of the 3 biomarkers to established prognostic factors significantly improved prediction for mortality, as shown by the net reclassification improvement (0.481, p < 0.001) [corrected] and integrated discrimination improvement (0.0226, p = 0.03) [corrected]. CONCLUSIONS Our data suggest that addition of a multimarker to a model including established risk factors improves the prediction of mortality in STEMI patients undergoing primary percutaneous coronary intervention. Furthermore, the use of a simple risk score based on these biomarkers identifies a high-risk subgroup.
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Affiliation(s)
- Peter Damman
- Department of Cardiology, Academic Medical Center–University of Amsterdam, Amsterdam, the Netherlands
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Iversen KK, Teisner B, Winkel P, Gluud C, Kjøller E, Kolmos HJ, Hildebrandt PR, Hilden J, Kastrup J. Pregnancy associated plasma protein-A as a marker for myocardial infarction and death in patients with stable coronary artery disease: A prognostic study within the CLARICOR Trial. Atherosclerosis 2011; 214:203-8. [DOI: 10.1016/j.atherosclerosis.2010.10.025] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Revised: 10/02/2010] [Accepted: 10/07/2010] [Indexed: 10/18/2022]
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Liu P, Yan J, Gong J, Wang C, Chen G. Positive correlation between pregnancy-associated plasma protein-A level and OX40 ligand expression in patients with acute coronary syndromes. Biomed Pharmacother 2010; 65:193-7. [PMID: 21111564 DOI: 10.1016/j.biopha.2010.10.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Accepted: 10/12/2010] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Increasing evidence show that serum pregnancy-associated plasma protein-A (PAPP-A) and OX40 ligand (OX40L) expression have been implicated in acute coronary syndromes (ACS). We investigated the relationship between PAPP-A level and OX40L in serum and membrane-bound OX40L in patients with ACS. METHODS The present study included normal controls (n=30), patients with stable angina (SA) (n=60) and patients with ACS, including unstable angina (UA) (n=50) and acute myocardial infarction (AMI) (n=30). Serum concentrations of PAPP-A and soluble OX40L (sOX40L) were determined with Elisa, whereas the expression of OX40L on monocytes were analyzed with flow cytometry. RESULTS The expression of OX40L in peripheral monocytes in patients with UA [25.6±5.5 mean fluorescence intensity (MFI)] and AMI (29.4±6.3MFI) were significantly higher than those in patients with SA (10.6±2.8MFI) and controls (11.1±3.5MFI). Both sOX40L and PAPP-A in patients with UA (15.7±4.9ng/mL, 25.4±6.8μg/mL, respectively) and AMI (17.1±5.3ng/mL, 26.3±5.6μg/mL, respectively) were significantly higher than those in patients with SA (3.4±1.4ng/mL, 9.6±2.1μg/mL, respectively) and controls (3.9±1.3ng/mL, 8.5±2.8μg/mL, respectively) (P<0.001). Interestingly, a positive correlation was found between sOX40L, membrane-bound OX40L and serum PAPP-A levels (r(1)=0.54, r(2)=0.51; P<0.0001). Both serum and membrane-bound OX40L and PAPP-A levels significantly correlated with complex coronary stenosis (r(1)=0.56, r(2)=0.55, r(3)=0.40; P<0.001). CONCLUSION PAPP-A level was significantly related to soluble and membrane-bound OX40L in patients with ACS. Enhanced level of serum PAPP-A and sOX40L might represent a prognostic marker for coronary disease activity.
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Affiliation(s)
- Peijing Liu
- Division of Cardiology, Department of Medicine, The Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu Province, 212001 PR China
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Pregnancy-associated plasma protein-A in the pathophysiology, diagnosis, and prognosis of coronary heart disease. COR ET VASA 2010. [DOI: 10.33678/cor.2010.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Roubille F, Samri A, Cornillet L, Sportouch-Dukhan C, Davy JM, Raczka F, Gervasoni R, Pasquie JL, Cung TT, Piot C, Macia JC, Cransac F, Leclercq F. Routinely-feasible multiple biomarkers score to predict prognosis after revascularized STEMI. Eur J Intern Med 2010; 21:131-6. [PMID: 20206886 DOI: 10.1016/j.ejim.2009.11.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2009] [Revised: 11/22/2009] [Accepted: 11/25/2009] [Indexed: 11/23/2022]
Abstract
INTRODUCTION We assessed the long-term prognostic value of an easy-to-do multiple cardiac biomarkers score after a revascularized acute myocardial infarction (MI) in order to evaluate a multimarker approach to risk stratification, based on routine biomarkers. MATERIAL AND METHODS Blood samples from 138 patients hospitalized with acute myocardial infarction and successfully treated by primary coronary intervention (with TIMI 3 flow) were subsequently tested for creatinin level at admittance and then BNP, hsCRP, troponin I from Day 0 to day 7. The primary endpoint was a clinical evaluation comprising: new hospitalization for cardiac reasons, acute coronary events (acute coronary syndrome), and death. RESULTS During the median follow-up period of 11.01 months [9.44-12.59], 47 events were recorded. All the following markers were able to predict events: creatinemia on admission (p=0.0057), CRP on day 3 (p, troponin I on day 1 (p<0.001), BNP (p<0.0001) and biological multimarker score (p<0.0001). Clinical events were predicted with a hazard ratio (HR) of respectively 3.30 [2.88-12.30] in BNP Q4 as compared to the three lower quartiles (Q1-3), and 3.15 [2.75-21.00] for the Multimarker approach. The multimarker score was not significantly better than BNP on day 1 alone (p=0.77), troponin on day 1 alone (p=0.43), creatininemia on admission (p=0.19) or CRPhs on day 3 alone (p=0.054). Nevertheless, the Multimarker approach leads to the selection of a smaller, hence more manageable, high-risk population (13% versus 25%). CONCLUSION Among 138 subjects admitted for acute MI, and all successfully revascularized, a routinely multimarker approach with BNP, hsCRP, creatininemia, troponin I, is feasible. BNP is the most powerful marker, and this multimarker approach renders additional prognostic information helping to identify patients with high-risk to clinical events.
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Affiliation(s)
- F Roubille
- CHU Arnaud de Villeneuve, Cardiology Department, 371 avenue du doyen Gaston GIRAUD, 34295 Montpellier, France.
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Glycoprotein VI as a prognostic biomarker for cardiovascular death in patients with symptomatic coronary artery disease. Clin Res Cardiol 2010; 99:227-33. [DOI: 10.1007/s00392-009-0109-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2009] [Accepted: 12/22/2009] [Indexed: 10/20/2022]
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