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Myeloperoxidase aids prognostication together with NT-BNP in high-risk patients with acute ST elevation myocardial infarction

By Sohail Q. Khan, Dominic Kelly, Paulene Quinn, Joan E. Davies and Leong L. Ng

Abstract

This is the authors' final draft of the paper published as Heart, 2007, 93(7), pp.826-831. The definitive version is available from http://heart.bmj.com/cgi/content/abstract/93/7/826, doi:10.1136/hrt.2006.091041Background: Inflammation plays a critical role in acute myocardial infarction. One such inflammatory marker is myeloperoxidase (MPO). Its role as a predictor of death or MI in patients with ST segment elevation myocardial infarction (STEMI) is unclear. We sought to investigate this and compared it to N terminal pro B type natriuretic peptide (NT-BNP).\ud Method: We studied 384 post STEMI patients. Patients were followed-up for the combined endpoint of death or readmission with non-fatal MI.\ud Results: There were 40 deaths and 37 readmissions with MI. Median MPO was raised in patients experiencing death or MI compared to survivors (median [range] ng/ml, 50.6[15.3-124.1] vs. 33.5[6.6-400.2], p=0.001). Using a Cox proportional hazards model log median MPO (HR 6.91, 95% CI: 1.79-26.73, p=0.005) and log median NT-BNP (HR 4.21, 95% CI: 1.53-11.58, p=0.005) independently predicted death or non-fatal MI. MPO had predictive power in both below and above median NT-BNP levels (log rank 5.60, p=0.020, log rank 5.12, p=0.024 respectively). The receiver-operating curve for median NT-BNP yielded an area under the curve (AUC) of 0.72 (95% CI: 0.65-0.79, p<0.001); for median MPO the AUC was 0.62 (95% CI: 0.55-0.69, p=0.001). The logistic model combining the 2 markers yielded an AUC of 0.76 (95% CI: 0.69-0.82, p<0.001). Conclusion: MPO and NT-BNP may be useful tools for risk stratification of all acute coronary syndromes, including higher risk STEMI patients

Publisher: BMJ Publishing
Year: 2007
DOI identifier: 10.1136/hrt.2006.091041
OAI identifier: oai:lra.le.ac.uk:2381/3565

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