Myeloperoxidase in the diagnosis of acute coronary syndromes: The importance of spectrum

W. Frank Peacock, John Nagurney, Robert Birkhahn, Adam Singer, Nathan Shapiro, Judd Hollander, Ted Glynn, Richard Nowak, Basmah Safdar, Chadwick Miller, Mary Peberdy, Francis Counselman, Abhinav Chandra, Joshua Kosowsky, James Neuenschwander, Jon Schrock, Stephen Plantholt, Elizabeth Lewandrowski, Vance Wong, Ken KupferDeborah Diercks

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Background: Myeloperoxidase (MPO) is proposed for risk stratification in patients with suspected acute coronary syndromes (ACSs). We determined if MPO has diagnostic value in patients being evaluated for ACS. Method: MIDAS was an 18-center prospective study enrolling suspected ACS emergency department patients who presented <8 hours after symptom onset and in whom serial cardiac markers and objective cardiac perfusion testing were planned. Blinded MPO (Biosite, Inc, San Diego, CA) and troponin I (Triage Cardio 3; Biosite, Inc) were drawn at arrival, and Troponin I (TnI) was measured at 90, 180, and 360 minutes. Final diagnoses were adjudicated by the local investigator blinded to study assay. Results: Of 1,018 patients, 54% were male, 26% black, with a mean age of 58 ± 13 years. Diagnoses were ACS in 288 (23%) and noncardiac chest pain (NCCP) in 788 (77%). Of patients with ACS, 94 (9.2%) had a myocardial infarction (MI) at presentation (69 non-ST-elevation MI, 25 ST-elevation MI), and 136 had unstable angina. Using a cutpoint of 210 ng/mL to provide 90% specificity, MPO had a sensitivity of 0.18; negative predictive value, 0.69; positive predictive value, 0.47; negative likelihood ratio, 0.91; and a positive likelihood ratio of 1.83 to differentiate ACS and NCCP. Because of the large overlap of quartiles, MPO was not clinically useful to predict serial TnI changes. The C statistics ± 95% CI for MPO differentiating ACS from NCCP and for AMI versus NCCP were 0.629 ± 0.04 and 0.666 ± 0.06, respectively. Conclusions: Myeloperoxidase has insufficient accuracy for decision making in patients with suspected ACS.

Original languageEnglish (US)
Pages (from-to)893-899
Number of pages7
JournalAmerican Heart Journal
Volume162
Issue number5
DOIs
StatePublished - Nov 2011

Fingerprint

Acute Coronary Syndrome
Peroxidase
Chest Pain
Troponin I
Triage
Unstable Angina
Hospital Emergency Service
Decision Making
Perfusion
Myocardial Infarction
Research Personnel
Prospective Studies

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Peacock, W. F., Nagurney, J., Birkhahn, R., Singer, A., Shapiro, N., Hollander, J., ... Diercks, D. (2011). Myeloperoxidase in the diagnosis of acute coronary syndromes: The importance of spectrum. American Heart Journal, 162(5), 893-899. https://doi.org/10.1016/j.ahj.2011.08.017

Myeloperoxidase in the diagnosis of acute coronary syndromes : The importance of spectrum. / Peacock, W. Frank; Nagurney, John; Birkhahn, Robert; Singer, Adam; Shapiro, Nathan; Hollander, Judd; Glynn, Ted; Nowak, Richard; Safdar, Basmah; Miller, Chadwick; Peberdy, Mary; Counselman, Francis; Chandra, Abhinav; Kosowsky, Joshua; Neuenschwander, James; Schrock, Jon; Plantholt, Stephen; Lewandrowski, Elizabeth; Wong, Vance; Kupfer, Ken; Diercks, Deborah.

In: American Heart Journal, Vol. 162, No. 5, 11.2011, p. 893-899.

Research output: Contribution to journalArticle

Peacock, WF, Nagurney, J, Birkhahn, R, Singer, A, Shapiro, N, Hollander, J, Glynn, T, Nowak, R, Safdar, B, Miller, C, Peberdy, M, Counselman, F, Chandra, A, Kosowsky, J, Neuenschwander, J, Schrock, J, Plantholt, S, Lewandrowski, E, Wong, V, Kupfer, K & Diercks, D 2011, 'Myeloperoxidase in the diagnosis of acute coronary syndromes: The importance of spectrum', American Heart Journal, vol. 162, no. 5, pp. 893-899. https://doi.org/10.1016/j.ahj.2011.08.017
Peacock WF, Nagurney J, Birkhahn R, Singer A, Shapiro N, Hollander J et al. Myeloperoxidase in the diagnosis of acute coronary syndromes: The importance of spectrum. American Heart Journal. 2011 Nov;162(5):893-899. https://doi.org/10.1016/j.ahj.2011.08.017
Peacock, W. Frank ; Nagurney, John ; Birkhahn, Robert ; Singer, Adam ; Shapiro, Nathan ; Hollander, Judd ; Glynn, Ted ; Nowak, Richard ; Safdar, Basmah ; Miller, Chadwick ; Peberdy, Mary ; Counselman, Francis ; Chandra, Abhinav ; Kosowsky, Joshua ; Neuenschwander, James ; Schrock, Jon ; Plantholt, Stephen ; Lewandrowski, Elizabeth ; Wong, Vance ; Kupfer, Ken ; Diercks, Deborah. / Myeloperoxidase in the diagnosis of acute coronary syndromes : The importance of spectrum. In: American Heart Journal. 2011 ; Vol. 162, No. 5. pp. 893-899.
@article{61ebcccd19c34177a0a6e4372741860c,
title = "Myeloperoxidase in the diagnosis of acute coronary syndromes: The importance of spectrum",
abstract = "Background: Myeloperoxidase (MPO) is proposed for risk stratification in patients with suspected acute coronary syndromes (ACSs). We determined if MPO has diagnostic value in patients being evaluated for ACS. Method: MIDAS was an 18-center prospective study enrolling suspected ACS emergency department patients who presented <8 hours after symptom onset and in whom serial cardiac markers and objective cardiac perfusion testing were planned. Blinded MPO (Biosite, Inc, San Diego, CA) and troponin I (Triage Cardio 3; Biosite, Inc) were drawn at arrival, and Troponin I (TnI) was measured at 90, 180, and 360 minutes. Final diagnoses were adjudicated by the local investigator blinded to study assay. Results: Of 1,018 patients, 54{\%} were male, 26{\%} black, with a mean age of 58 ± 13 years. Diagnoses were ACS in 288 (23{\%}) and noncardiac chest pain (NCCP) in 788 (77{\%}). Of patients with ACS, 94 (9.2{\%}) had a myocardial infarction (MI) at presentation (69 non-ST-elevation MI, 25 ST-elevation MI), and 136 had unstable angina. Using a cutpoint of 210 ng/mL to provide 90{\%} specificity, MPO had a sensitivity of 0.18; negative predictive value, 0.69; positive predictive value, 0.47; negative likelihood ratio, 0.91; and a positive likelihood ratio of 1.83 to differentiate ACS and NCCP. Because of the large overlap of quartiles, MPO was not clinically useful to predict serial TnI changes. The C statistics ± 95{\%} CI for MPO differentiating ACS from NCCP and for AMI versus NCCP were 0.629 ± 0.04 and 0.666 ± 0.06, respectively. Conclusions: Myeloperoxidase has insufficient accuracy for decision making in patients with suspected ACS.",
author = "Peacock, {W. Frank} and John Nagurney and Robert Birkhahn and Adam Singer and Nathan Shapiro and Judd Hollander and Ted Glynn and Richard Nowak and Basmah Safdar and Chadwick Miller and Mary Peberdy and Francis Counselman and Abhinav Chandra and Joshua Kosowsky and James Neuenschwander and Jon Schrock and Stephen Plantholt and Elizabeth Lewandrowski and Vance Wong and Ken Kupfer and Deborah Diercks",
year = "2011",
month = "11",
doi = "10.1016/j.ahj.2011.08.017",
language = "English (US)",
volume = "162",
pages = "893--899",
journal = "American Heart Journal",
issn = "0002-8703",
publisher = "Mosby Inc.",
number = "5",

}

TY - JOUR

T1 - Myeloperoxidase in the diagnosis of acute coronary syndromes

T2 - The importance of spectrum

AU - Peacock, W. Frank

AU - Nagurney, John

AU - Birkhahn, Robert

AU - Singer, Adam

AU - Shapiro, Nathan

AU - Hollander, Judd

AU - Glynn, Ted

AU - Nowak, Richard

AU - Safdar, Basmah

AU - Miller, Chadwick

AU - Peberdy, Mary

AU - Counselman, Francis

AU - Chandra, Abhinav

AU - Kosowsky, Joshua

AU - Neuenschwander, James

AU - Schrock, Jon

AU - Plantholt, Stephen

AU - Lewandrowski, Elizabeth

AU - Wong, Vance

AU - Kupfer, Ken

AU - Diercks, Deborah

PY - 2011/11

Y1 - 2011/11

N2 - Background: Myeloperoxidase (MPO) is proposed for risk stratification in patients with suspected acute coronary syndromes (ACSs). We determined if MPO has diagnostic value in patients being evaluated for ACS. Method: MIDAS was an 18-center prospective study enrolling suspected ACS emergency department patients who presented <8 hours after symptom onset and in whom serial cardiac markers and objective cardiac perfusion testing were planned. Blinded MPO (Biosite, Inc, San Diego, CA) and troponin I (Triage Cardio 3; Biosite, Inc) were drawn at arrival, and Troponin I (TnI) was measured at 90, 180, and 360 minutes. Final diagnoses were adjudicated by the local investigator blinded to study assay. Results: Of 1,018 patients, 54% were male, 26% black, with a mean age of 58 ± 13 years. Diagnoses were ACS in 288 (23%) and noncardiac chest pain (NCCP) in 788 (77%). Of patients with ACS, 94 (9.2%) had a myocardial infarction (MI) at presentation (69 non-ST-elevation MI, 25 ST-elevation MI), and 136 had unstable angina. Using a cutpoint of 210 ng/mL to provide 90% specificity, MPO had a sensitivity of 0.18; negative predictive value, 0.69; positive predictive value, 0.47; negative likelihood ratio, 0.91; and a positive likelihood ratio of 1.83 to differentiate ACS and NCCP. Because of the large overlap of quartiles, MPO was not clinically useful to predict serial TnI changes. The C statistics ± 95% CI for MPO differentiating ACS from NCCP and for AMI versus NCCP were 0.629 ± 0.04 and 0.666 ± 0.06, respectively. Conclusions: Myeloperoxidase has insufficient accuracy for decision making in patients with suspected ACS.

AB - Background: Myeloperoxidase (MPO) is proposed for risk stratification in patients with suspected acute coronary syndromes (ACSs). We determined if MPO has diagnostic value in patients being evaluated for ACS. Method: MIDAS was an 18-center prospective study enrolling suspected ACS emergency department patients who presented <8 hours after symptom onset and in whom serial cardiac markers and objective cardiac perfusion testing were planned. Blinded MPO (Biosite, Inc, San Diego, CA) and troponin I (Triage Cardio 3; Biosite, Inc) were drawn at arrival, and Troponin I (TnI) was measured at 90, 180, and 360 minutes. Final diagnoses were adjudicated by the local investigator blinded to study assay. Results: Of 1,018 patients, 54% were male, 26% black, with a mean age of 58 ± 13 years. Diagnoses were ACS in 288 (23%) and noncardiac chest pain (NCCP) in 788 (77%). Of patients with ACS, 94 (9.2%) had a myocardial infarction (MI) at presentation (69 non-ST-elevation MI, 25 ST-elevation MI), and 136 had unstable angina. Using a cutpoint of 210 ng/mL to provide 90% specificity, MPO had a sensitivity of 0.18; negative predictive value, 0.69; positive predictive value, 0.47; negative likelihood ratio, 0.91; and a positive likelihood ratio of 1.83 to differentiate ACS and NCCP. Because of the large overlap of quartiles, MPO was not clinically useful to predict serial TnI changes. The C statistics ± 95% CI for MPO differentiating ACS from NCCP and for AMI versus NCCP were 0.629 ± 0.04 and 0.666 ± 0.06, respectively. Conclusions: Myeloperoxidase has insufficient accuracy for decision making in patients with suspected ACS.

UR - http://www.scopus.com/inward/record.url?scp=81255214697&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=81255214697&partnerID=8YFLogxK

U2 - 10.1016/j.ahj.2011.08.017

DO - 10.1016/j.ahj.2011.08.017

M3 - Article

C2 - 22093206

AN - SCOPUS:81255214697

VL - 162

SP - 893

EP - 899

JO - American Heart Journal

JF - American Heart Journal

SN - 0002-8703

IS - 5

ER -