Higher MPO levels have significant event rates at 72-h, 30-day, and 6-month follow-up visits.
Cad risk factors timi trial#
The CAPTURE trial enrolled 1265 patients with ACS. The prognostic potential of MPO was first described Brennan in 2003 as an independent predictor of MACEs (myocardial infarction, re-infarction, the need for revascularization, or death) in the 6 months following admission to the emergency department for chest pain. Atherosclerosis involves modification of low-density lipoprotein particles, impaired endothelial function, destabilization of atherosclerotic plaques, and the induction of apoptosis. Ītherosclerosis is a complex process in which the leukocyte-derived enzyme myeloperoxidase (MPO) plays an important role. Patients with a low CRP concentration (2%). Several studies demonstrate a higher rate of adverse events and 30-day mortality in association with elevated CRP levels.ĬRP in combination with troponin adds prognostic value. Īnimal studies show a negative effect on the myocardium after injecting human CRP into the rat coronary artery. Measuring CRP levels by real-time polymerase chain reaction demonstrate increased production due to unstable atherosclerotic plaques and their direct effect on endothelial dysfunction. The concept that C-reactive protein (CRP) is produced solely by hepatic cells during inflammation has been questioned. The role of acute-phase proteins has been investigated in recent years.
Interestingly, higher troponin levels do not necessarily equal a higher risk of re-infarction, although mortality remains high. Patients admitted to the emergency department for suspected ACS and who were subsequently discharged without an acute cardiovascular event have higher mortality in association with mildly elevated troponin (after 2 and 5.8 years of follow-up). Troponin is considered an independent risk factor for all-cause mortality in the general population (without ACS). Physiological changes in older patients may be responsible for such results. Low troponin levels are associated more with high mortality in older patients with ACS than with younger patients. However, the prognostic value is attenuated in older patients. Current ESC guidelines recommend that troponin should be measured serially to determine the prognosis in patients with ACS (Class I, level B). High troponin levels predict an increased risk of mortality, and high-sensitivity troponin (hs-Tn)-T seems to be a better predictor than hs-Tn-I. Current European Society of Cardiology (ESC) guidelines recommend the use of NT-proBNP as a prognostic factor in patients with ACS (Class IIa, level B), but the use of other biomarkers is not recommended. An elevated NT-proBNP level in a patient with ACS successfully predicts a worse prognosis (mortality, development of left ventricular systolic dysfunction). It has been suggested that an elevated N-terminal fraction of brain natriuretic peptide (NT-proBNP) level may be caused by transient myocardial ischemia, even without left ventricular systolic dysfunction.
Several biomarkers have been proposed to define the prognosis of patients with ACS, many of which are routinely used in everyday clinical practice.
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