Koch Christian, Henrich Michael, Heidt Martin Clemens
Department of Anesthesiology and Intensive Care Medicine, University Hospital of Giessen and Marburg, Giessen, Germany.
Clin Cardiol. 2014 Dec;37(12):744-9. doi: 10.1002/clc.22336. Epub 2014 Nov 17.
Myeloperoxidase (MPO) plasma values predict major adverse cardiac events (MACE) in cases of acute coronary syndrome. The effect of serial testing in patients who are suspected for acute coronary ischemia is unclear.
We hypothesize that sequential MPO measurement may improve prediction of MACE in patients with suspected acute coronary ischemia.
The present prospective observational study examined the prognostic significance of MPO in 917 patients with suspicion of acute coronary syndrome. Blood samples were taken at cardiac catheter laboratory admission and the day after coronary angiography. We recorded patients' mortality, the occurrence of cardiac ischemia, and repeated percutaneous coronary intervention through the next 6 months.
Mortality among patients with increased MPO plasma levels the day after coronary angiography was increased significantly (P < 0.01). Patients with MPO values above 306.3 pmol/L had a significantly higher incidence of 6-month MACE (P < 0.0001) than patients with lower plasma values. Cox proportional hazards multivariate regression analyses revealed that MPO was an independent marker for MACE after suspected acute coronary ischemia (P = 0.048). However, MPO plasma levels at cardiac catheter laboratory admission showed no prognostic significance.
In patients with suspected myocardial infarction, MPO levels above 306.3 pmol/L measured 24 hours after onset of symptoms were independent predictors of 6-month mortality and MACE.
髓过氧化物酶(MPO)血浆值可预测急性冠状动脉综合征患者的主要不良心脏事件(MACE)。对于疑似急性冠状动脉缺血患者进行系列检测的效果尚不清楚。
我们假设连续检测MPO可能会改善对疑似急性冠状动脉缺血患者MACE的预测。
本前瞻性观察性研究检测了917例疑似急性冠状动脉综合征患者中MPO的预后意义。在心脏导管实验室入院时及冠状动脉造影后第二天采集血样。我们记录了患者的死亡率、心脏缺血的发生情况以及接下来6个月内重复进行的经皮冠状动脉介入治疗。
冠状动脉造影后第二天MPO血浆水平升高的患者死亡率显著增加(P < 0.01)。MPO值高于306.3 pmol/L的患者6个月MACE发生率显著高于血浆值较低的患者(P < 0.0001)。Cox比例风险多变量回归分析显示,MPO是疑似急性冠状动脉缺血后MACE的独立标志物(P = 0.048)。然而,心脏导管实验室入院时的MPO血浆水平无预后意义。
在疑似心肌梗死患者中,症状发作24小时后测得的MPO水平高于306.3 pmol/L是6个月死亡率和MACE的独立预测指标。