Serial Analyses of C-Reactive Protein and Myeloperoxidase in Acute Coronary Syndrome
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BACKGROUND: C-reactive protein (CRP) and myeloperoxidase (MPO) are involved in the pathogenesis of atherosclerosis, mainly during periods of instabilization. This study aims to test the hypothesis that patients with acute coronary syndrome (ACS) maintain a persistent inflammatory state, and that this is associated with long-term mortality. HYPOTHESIS: We hypothesized that serum C-reactive protein and myeloperoxidase collected at the index event and later, could add to the prognostic information in patients with ACS. METHODS: In a prospective cohort of 115 consecutive patients with ACS, myeloperoxidase and C-reactive protein were measured at admission and 2 y later. Patients were followed-up for the occurrence of cardiac death and other major cardiac events. RESULTS: Levels of CRP decreased from 26 +/- 34 mg/L in the acute phase to 6 +/- 8 mg/L in the chronic phase (p < 0.001), and MPO levels decreased from 86 +/- 43 pM to 27 +/- 32 pM (p < 0.001). After 29 +/- 12 mo, 27% patients died, 39% had new episode of ACS, and 30% underwent revascularization procedures. Initial CRP levels above 10 mg/L were associated with higher long-term mortality (hazard ratio [HR]: 2.43; 95% confidence interval [CI]: 0.98 to 6.07; p = 0.048). MPO levels were not associated with death or other major events. CONCLUSIONS: Changes over time or absolute values in the chronic phase of both markers were not associated with clinical outcomes. CRP levels, but not MPO levels, in the index event were predictive of long-term cardiovascular mortality.
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