Myeloperoxidase serum levels predict risk in patients with acute coronary syndromes

Stephan Baldus, Christopher Heeschen, Thomas Meinertz, Andreas M. Zeiher, Jason P. Eiserich, Thomas Münzel, Maarten L. Simoons, Christian W. Hamm

Research output: Contribution to journalArticle

738 Citations (Scopus)

Abstract

Background - Polymorphonuclear neutrophils (PMNs) have gained attention as critical mediators of acute coronary syndromes (ACS). Myeloperoxidase (MPO), a hemoprotein abundantly expressed by PMNs and secreted during activation, possesses potent proinflammatory properties and may contribute directly to tissue injury. However, whether MPO also provides prognostic information in patients with ACS remains unknown. Methods and Results - MPO serum levels were assessed in 1090 patients with ACS. We recorded death and myocardial infarctions during 6 months of follow-up. MPO levels did not correlate with troponin T, soluble CD40 ligand, or C-reactive protein levels or with ST-segment changes. However, patients with elevated MPO levels (>350 μg/ L; 31.3%) experienced a markedly increased cardiac risk (adjusted hazard ratio [HR] 2.25 [1.32 to 3.82]; P=0.003). In particular, MPO serum levels identified patients at risk who had troponin T levels below 0.01 μg/L (adjusted HR 7.48 [95% CI 1.98 to 28.29]; P=0.001). In a multivariate model that included other biochemical markers, troponin T (HR 1.99; P=0.023), C-reactive protein (1.25; P=0.044), vascular endothelial growth factor (HR 1.87; P=0.041), soluble CD40 ligand (HR 2.78; P<0.001), and MPO (HR 2.11; P=0.008) were all independent predictors of the patient's 6-month outcome. Conclusions - In patients with ACS, MPO serum levels powerfully predict an increased risk for subsequent cardiovascular events and extend the prognostic information gained from traditional biochemical markers. Given its proinflammatory properties, MPO may serve as both a marker and mediator of vascular inflammation and further points toward the significance of PMN activation in the pathophysiology of ACS.

Original languageEnglish (US)
Pages (from-to)1440-1445
Number of pages6
JournalCirculation
Volume108
Issue number12
DOIs
StatePublished - Sep 23 2003

Fingerprint

Acute Coronary Syndrome
Peroxidase
Serum
Troponin T
CD40 Ligand
C-Reactive Protein
Neutrophils
Biomarkers
Inflammation Mediators
Neutrophil Activation
Vascular Endothelial Growth Factor A
Blood Vessels
Myocardial Infarction
Wounds and Injuries

Keywords

  • Angina
  • Inflammation
  • Leukocytes
  • Myocardial infarction
  • Prognosis

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Baldus, S., Heeschen, C., Meinertz, T., Zeiher, A. M., Eiserich, J. P., Münzel, T., ... Hamm, C. W. (2003). Myeloperoxidase serum levels predict risk in patients with acute coronary syndromes. Circulation, 108(12), 1440-1445. https://doi.org/10.1161/01.CIR.0000090690.67322.51

Myeloperoxidase serum levels predict risk in patients with acute coronary syndromes. / Baldus, Stephan; Heeschen, Christopher; Meinertz, Thomas; Zeiher, Andreas M.; Eiserich, Jason P.; Münzel, Thomas; Simoons, Maarten L.; Hamm, Christian W.

In: Circulation, Vol. 108, No. 12, 23.09.2003, p. 1440-1445.

Research output: Contribution to journalArticle

Baldus, S, Heeschen, C, Meinertz, T, Zeiher, AM, Eiserich, JP, Münzel, T, Simoons, ML & Hamm, CW 2003, 'Myeloperoxidase serum levels predict risk in patients with acute coronary syndromes', Circulation, vol. 108, no. 12, pp. 1440-1445. https://doi.org/10.1161/01.CIR.0000090690.67322.51
Baldus S, Heeschen C, Meinertz T, Zeiher AM, Eiserich JP, Münzel T et al. Myeloperoxidase serum levels predict risk in patients with acute coronary syndromes. Circulation. 2003 Sep 23;108(12):1440-1445. https://doi.org/10.1161/01.CIR.0000090690.67322.51
Baldus, Stephan ; Heeschen, Christopher ; Meinertz, Thomas ; Zeiher, Andreas M. ; Eiserich, Jason P. ; Münzel, Thomas ; Simoons, Maarten L. ; Hamm, Christian W. / Myeloperoxidase serum levels predict risk in patients with acute coronary syndromes. In: Circulation. 2003 ; Vol. 108, No. 12. pp. 1440-1445.
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abstract = "Background - Polymorphonuclear neutrophils (PMNs) have gained attention as critical mediators of acute coronary syndromes (ACS). Myeloperoxidase (MPO), a hemoprotein abundantly expressed by PMNs and secreted during activation, possesses potent proinflammatory properties and may contribute directly to tissue injury. However, whether MPO also provides prognostic information in patients with ACS remains unknown. Methods and Results - MPO serum levels were assessed in 1090 patients with ACS. We recorded death and myocardial infarctions during 6 months of follow-up. MPO levels did not correlate with troponin T, soluble CD40 ligand, or C-reactive protein levels or with ST-segment changes. However, patients with elevated MPO levels (>350 μg/ L; 31.3{\%}) experienced a markedly increased cardiac risk (adjusted hazard ratio [HR] 2.25 [1.32 to 3.82]; P=0.003). In particular, MPO serum levels identified patients at risk who had troponin T levels below 0.01 μg/L (adjusted HR 7.48 [95{\%} CI 1.98 to 28.29]; P=0.001). In a multivariate model that included other biochemical markers, troponin T (HR 1.99; P=0.023), C-reactive protein (1.25; P=0.044), vascular endothelial growth factor (HR 1.87; P=0.041), soluble CD40 ligand (HR 2.78; P<0.001), and MPO (HR 2.11; P=0.008) were all independent predictors of the patient's 6-month outcome. Conclusions - In patients with ACS, MPO serum levels powerfully predict an increased risk for subsequent cardiovascular events and extend the prognostic information gained from traditional biochemical markers. Given its proinflammatory properties, MPO may serve as both a marker and mediator of vascular inflammation and further points toward the significance of PMN activation in the pathophysiology of ACS.",
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AU - Baldus, Stephan

AU - Heeschen, Christopher

AU - Meinertz, Thomas

AU - Zeiher, Andreas M.

AU - Eiserich, Jason P.

AU - Münzel, Thomas

AU - Simoons, Maarten L.

AU - Hamm, Christian W.

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N2 - Background - Polymorphonuclear neutrophils (PMNs) have gained attention as critical mediators of acute coronary syndromes (ACS). Myeloperoxidase (MPO), a hemoprotein abundantly expressed by PMNs and secreted during activation, possesses potent proinflammatory properties and may contribute directly to tissue injury. However, whether MPO also provides prognostic information in patients with ACS remains unknown. Methods and Results - MPO serum levels were assessed in 1090 patients with ACS. We recorded death and myocardial infarctions during 6 months of follow-up. MPO levels did not correlate with troponin T, soluble CD40 ligand, or C-reactive protein levels or with ST-segment changes. However, patients with elevated MPO levels (>350 μg/ L; 31.3%) experienced a markedly increased cardiac risk (adjusted hazard ratio [HR] 2.25 [1.32 to 3.82]; P=0.003). In particular, MPO serum levels identified patients at risk who had troponin T levels below 0.01 μg/L (adjusted HR 7.48 [95% CI 1.98 to 28.29]; P=0.001). In a multivariate model that included other biochemical markers, troponin T (HR 1.99; P=0.023), C-reactive protein (1.25; P=0.044), vascular endothelial growth factor (HR 1.87; P=0.041), soluble CD40 ligand (HR 2.78; P<0.001), and MPO (HR 2.11; P=0.008) were all independent predictors of the patient's 6-month outcome. Conclusions - In patients with ACS, MPO serum levels powerfully predict an increased risk for subsequent cardiovascular events and extend the prognostic information gained from traditional biochemical markers. Given its proinflammatory properties, MPO may serve as both a marker and mediator of vascular inflammation and further points toward the significance of PMN activation in the pathophysiology of ACS.

AB - Background - Polymorphonuclear neutrophils (PMNs) have gained attention as critical mediators of acute coronary syndromes (ACS). Myeloperoxidase (MPO), a hemoprotein abundantly expressed by PMNs and secreted during activation, possesses potent proinflammatory properties and may contribute directly to tissue injury. However, whether MPO also provides prognostic information in patients with ACS remains unknown. Methods and Results - MPO serum levels were assessed in 1090 patients with ACS. We recorded death and myocardial infarctions during 6 months of follow-up. MPO levels did not correlate with troponin T, soluble CD40 ligand, or C-reactive protein levels or with ST-segment changes. However, patients with elevated MPO levels (>350 μg/ L; 31.3%) experienced a markedly increased cardiac risk (adjusted hazard ratio [HR] 2.25 [1.32 to 3.82]; P=0.003). In particular, MPO serum levels identified patients at risk who had troponin T levels below 0.01 μg/L (adjusted HR 7.48 [95% CI 1.98 to 28.29]; P=0.001). In a multivariate model that included other biochemical markers, troponin T (HR 1.99; P=0.023), C-reactive protein (1.25; P=0.044), vascular endothelial growth factor (HR 1.87; P=0.041), soluble CD40 ligand (HR 2.78; P<0.001), and MPO (HR 2.11; P=0.008) were all independent predictors of the patient's 6-month outcome. Conclusions - In patients with ACS, MPO serum levels powerfully predict an increased risk for subsequent cardiovascular events and extend the prognostic information gained from traditional biochemical markers. Given its proinflammatory properties, MPO may serve as both a marker and mediator of vascular inflammation and further points toward the significance of PMN activation in the pathophysiology of ACS.

KW - Angina

KW - Inflammation

KW - Leukocytes

KW - Myocardial infarction

KW - Prognosis

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