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Baseline Plasma Myeloperoxidase Level Can Identify Risk for Imminent Major Cardiac Event

Measurement of plasma myeloperoxidase in patients who present to the emergency department with chest pain can predict the risk of myocardial infarction (MI), major cardiac events and revascularisation during the following 6-month period.

Myeloperoxidase levels at baseline predicted cardiovascular risk independently of C-reactive protein levels and other markers of inflammation, even if serial troponin T levels rule out myocardial infarction, report Stanley L. Hazen, MD, PhD, and colleagues at the Cleveland Clinic Foundation, Ohio, United States.

Myeloperoxidase levels were measured in 604 sequential patients who presented to the emergency department within 24 hours of chest pain onset. Thirty days and 6 months after presentation, patients were assessed for major adverse cardiac events  MI, need for revascularisation, or death. Myeloperoxidase levels were compared against those of 115 healthy adults with no history or clinical evidence of coronary artery disease.

Overall, 462 patients (mean age 61.4 years, 55% men) presented with MI. Of these, 142 patients (mean age of 66.5 years) presented with no MI (70.4% men).

Baseline median myeloperoxidase level of those with chest pain was 198 pM compared to 120 pM for controls (P < .001). While myeloperoxidase levels were higher among patients who presented within 2 hours of onset (mean 291 pM), levels were highest (mean 351 pM) among those who presented within 4.0 to 9.6 hours after symptom onset (P < .041).

Patients who needed revascularisation or had a major adverse cardiac event within either the 30-day or the 6-month follow up periods had higher levels of myeloperoxidase at baseline than did other patients. The 34 patients who died within 6 months had a mean myeloperoxidase level of 270 pM compared to 194 pM among survivors (P = .05).

In patients who were negative for troponin T, the frequency of major adverse cardiac events at 30 days and 6 months increased with increasing baseline myeloperoxidase quartiles (P < .001 for trend).

"Our results suggest that the addition of the measurement of myeloperoxidase to initial risk-stratification screening of patients presenting with chest pain may identify those at increased risk who might not otherwise be identified without invasive diagnostic testing," the authors conclude.

N Engl J Med 2003;349:1595-604. "Prognostic value of myeloperoxidase in patients with chest pain"

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