Concurrent evaluation of novel cardiac biomarkers in acute coronary syndrome

Myeloperoxidase and soluble CD40 ligand and the risk of recurrent ischaemic events in TACTICS-TIMI 18

David A. Morrow, Marc S. Sabatine, Marie Luise Brennan, James A de Lemos, Sabina A. Murphy, Christian T. Ruff, Nader Rifai, Christopher P. Cannon, Stanley L. Hazen

Research output: Contribution to journalArticle

133 Citations (Scopus)

Abstract

Aims: We investigated the prognostic performance of myeloperoxidase (MPO), and soluble CD40 ligand (sCD40L) along with B-type natriuretic peptide (BNP), high-sensitivity C-reactive protein (hsCRP), and cardiac troponin I (cTnI) for non-fatal recurrent ischaemic events in non-ST elevation acute coronary syndrome (ACS). Methods and results: We measured plasma MPO and sCD40L in 1524 patients with ACS treated with tirofiban and randomized to early invasive vs. conservative management in the TACTICS-TIMI 18 trial who survived to 180 days. Patients with elevated baseline MPO (>884 pM) were at higher risk of non-fatal myocardial infarction or rehospitalization for ACS at 30 days (9.3 vs. 4.6%, P < 0.001). In contrast, no difference was observed with higher sCD40L (>989 pg/mL, 7.6 vs. 6.3%, P = 0.31). MPO remained associated with recurrent ischaemic events after adjustment for age, ST-deviation, diabetes, prior coronary artery disease, heart failure, cTnI, hsCRP, and sCD40L (OR 2.10; 95% CI 1.36-3.23, P = 0.001). This association was attenuated by 180 days (OR 1.26; 0.95-1.68). Stratification using baseline MPO, BNP, and cTnI identified a >3-fold gradient of risk. Conclusion: MPO adds to BNP and cTnI for short-term risk assessment for recurrent ischaemic events in non-ST elevation ACS. sCD40L was not associated with risk in this population treated with a platelet GPIIb/IIIa receptor antagonist.

Original languageEnglish (US)
Pages (from-to)1096-1102
Number of pages7
JournalEuropean Heart Journal
Volume29
Issue number9
DOIs
StatePublished - May 2008

Fingerprint

CD40 Ligand
Acute Coronary Syndrome
Peroxidase
Troponin I
Biomarkers
Brain Natriuretic Peptide
tirofiban
C-Reactive Protein
Platelet Glycoprotein GPIIb-IIIa Complex
Coronary Artery Disease
Blood Platelets
Heart Failure
Myocardial Infarction
Population

Keywords

  • Biomarkers
  • Myocardial infarction
  • Prognosis
  • Unstable angina

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Concurrent evaluation of novel cardiac biomarkers in acute coronary syndrome : Myeloperoxidase and soluble CD40 ligand and the risk of recurrent ischaemic events in TACTICS-TIMI 18. / Morrow, David A.; Sabatine, Marc S.; Brennan, Marie Luise; de Lemos, James A; Murphy, Sabina A.; Ruff, Christian T.; Rifai, Nader; Cannon, Christopher P.; Hazen, Stanley L.

In: European Heart Journal, Vol. 29, No. 9, 05.2008, p. 1096-1102.

Research output: Contribution to journalArticle

Morrow, David A. ; Sabatine, Marc S. ; Brennan, Marie Luise ; de Lemos, James A ; Murphy, Sabina A. ; Ruff, Christian T. ; Rifai, Nader ; Cannon, Christopher P. ; Hazen, Stanley L. / Concurrent evaluation of novel cardiac biomarkers in acute coronary syndrome : Myeloperoxidase and soluble CD40 ligand and the risk of recurrent ischaemic events in TACTICS-TIMI 18. In: European Heart Journal. 2008 ; Vol. 29, No. 9. pp. 1096-1102.
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abstract = "Aims: We investigated the prognostic performance of myeloperoxidase (MPO), and soluble CD40 ligand (sCD40L) along with B-type natriuretic peptide (BNP), high-sensitivity C-reactive protein (hsCRP), and cardiac troponin I (cTnI) for non-fatal recurrent ischaemic events in non-ST elevation acute coronary syndrome (ACS). Methods and results: We measured plasma MPO and sCD40L in 1524 patients with ACS treated with tirofiban and randomized to early invasive vs. conservative management in the TACTICS-TIMI 18 trial who survived to 180 days. Patients with elevated baseline MPO (>884 pM) were at higher risk of non-fatal myocardial infarction or rehospitalization for ACS at 30 days (9.3 vs. 4.6{\%}, P < 0.001). In contrast, no difference was observed with higher sCD40L (>989 pg/mL, 7.6 vs. 6.3{\%}, P = 0.31). MPO remained associated with recurrent ischaemic events after adjustment for age, ST-deviation, diabetes, prior coronary artery disease, heart failure, cTnI, hsCRP, and sCD40L (OR 2.10; 95{\%} CI 1.36-3.23, P = 0.001). This association was attenuated by 180 days (OR 1.26; 0.95-1.68). Stratification using baseline MPO, BNP, and cTnI identified a >3-fold gradient of risk. Conclusion: MPO adds to BNP and cTnI for short-term risk assessment for recurrent ischaemic events in non-ST elevation ACS. sCD40L was not associated with risk in this population treated with a platelet GPIIb/IIIa receptor antagonist.",
keywords = "Biomarkers, Myocardial infarction, Prognosis, Unstable angina",
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T2 - Myeloperoxidase and soluble CD40 ligand and the risk of recurrent ischaemic events in TACTICS-TIMI 18

AU - Morrow, David A.

AU - Sabatine, Marc S.

AU - Brennan, Marie Luise

AU - de Lemos, James A

AU - Murphy, Sabina A.

AU - Ruff, Christian T.

AU - Rifai, Nader

AU - Cannon, Christopher P.

AU - Hazen, Stanley L.

PY - 2008/5

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N2 - Aims: We investigated the prognostic performance of myeloperoxidase (MPO), and soluble CD40 ligand (sCD40L) along with B-type natriuretic peptide (BNP), high-sensitivity C-reactive protein (hsCRP), and cardiac troponin I (cTnI) for non-fatal recurrent ischaemic events in non-ST elevation acute coronary syndrome (ACS). Methods and results: We measured plasma MPO and sCD40L in 1524 patients with ACS treated with tirofiban and randomized to early invasive vs. conservative management in the TACTICS-TIMI 18 trial who survived to 180 days. Patients with elevated baseline MPO (>884 pM) were at higher risk of non-fatal myocardial infarction or rehospitalization for ACS at 30 days (9.3 vs. 4.6%, P < 0.001). In contrast, no difference was observed with higher sCD40L (>989 pg/mL, 7.6 vs. 6.3%, P = 0.31). MPO remained associated with recurrent ischaemic events after adjustment for age, ST-deviation, diabetes, prior coronary artery disease, heart failure, cTnI, hsCRP, and sCD40L (OR 2.10; 95% CI 1.36-3.23, P = 0.001). This association was attenuated by 180 days (OR 1.26; 0.95-1.68). Stratification using baseline MPO, BNP, and cTnI identified a >3-fold gradient of risk. Conclusion: MPO adds to BNP and cTnI for short-term risk assessment for recurrent ischaemic events in non-ST elevation ACS. sCD40L was not associated with risk in this population treated with a platelet GPIIb/IIIa receptor antagonist.

AB - Aims: We investigated the prognostic performance of myeloperoxidase (MPO), and soluble CD40 ligand (sCD40L) along with B-type natriuretic peptide (BNP), high-sensitivity C-reactive protein (hsCRP), and cardiac troponin I (cTnI) for non-fatal recurrent ischaemic events in non-ST elevation acute coronary syndrome (ACS). Methods and results: We measured plasma MPO and sCD40L in 1524 patients with ACS treated with tirofiban and randomized to early invasive vs. conservative management in the TACTICS-TIMI 18 trial who survived to 180 days. Patients with elevated baseline MPO (>884 pM) were at higher risk of non-fatal myocardial infarction or rehospitalization for ACS at 30 days (9.3 vs. 4.6%, P < 0.001). In contrast, no difference was observed with higher sCD40L (>989 pg/mL, 7.6 vs. 6.3%, P = 0.31). MPO remained associated with recurrent ischaemic events after adjustment for age, ST-deviation, diabetes, prior coronary artery disease, heart failure, cTnI, hsCRP, and sCD40L (OR 2.10; 95% CI 1.36-3.23, P = 0.001). This association was attenuated by 180 days (OR 1.26; 0.95-1.68). Stratification using baseline MPO, BNP, and cTnI identified a >3-fold gradient of risk. Conclusion: MPO adds to BNP and cTnI for short-term risk assessment for recurrent ischaemic events in non-ST elevation ACS. sCD40L was not associated with risk in this population treated with a platelet GPIIb/IIIa receptor antagonist.

KW - Biomarkers

KW - Myocardial infarction

KW - Prognosis

KW - Unstable angina

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