TY - JOUR
T1 - Concurrent evaluation of novel cardiac biomarkers in acute coronary syndrome
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.
N1 - Funding Information:
TACTICS-TIMI 18 was supported by Merck and Co. Support for reagents and testing of sCD40L was provided by Beckman-Coulter (Chaska, MN, USA). Testing of MPO was supported by National Institutes of Health grant P01 HL076491. D.A.M. and M.S.S. are supported in part by NIH grant U01 HL083-1341.
Funding Information:
Conflict of interest: Disclosures of Relationships with Industry. The TIMI Study Group has received significant research grant support from Accumetrics, Amgen, Astra-Zeneca, Bayer Healthcare, Beckman Coulter, Biosite, Bristol-Myers Squibb, CV Therapeutics, Eli Lilly and Co, GlaxoSmithKline, Inotek Pharmaceuticals, Integrated Therapeutics, Merck and Company, Merck-Schering Plough Joint Venture, Millennium Pharmaceuticals, Novartis Pharmaceuticals, Nuvelo, Ortho-Clinical Diagnostics, Pfizer, Roche Diagnostics, Sanofi-Aventis, Sanofi-Synthelabo, and Schering-Plough. Dr. Morrow has received honoraria for educational presentations from Bayer Diagnostics, Beckman-Coulter, Dade-Behring, Sanofi-Aventis, and Roche Diagnostics. He has served as a consultant for GlaxoSmithKline and Sanofi-Aventis and on advisory boards for Critical Diagnostics, Genentech, OrthoClinical Diagnostics and Beckman-Coulter. Dr. de Lemos has received grant support from Merck, Biosite and Roche Diagnostics, has served as a consultant to Roche Diagnostics, Biosite, Inverness Medical, and Bayer Diagnostics, and has received speaker honoraria from Merck and Biosite. Dr. Cannon serves on advisory boards for AstraZeneca, Bristol-Myers Squibb, GlaxoSmithKline, Merck and Company, Pfizer, Sanofi-Aventis and Schering-Plough, and has received lecture fees or honoraria for educational materials from Accumetrics, AstraZeneca, Bristol-Myers Squibb, Merck and Company, Pfizer, Sanofi-Aventis, Scher-ing-Plough, BGB New York, DIME, and NCME. Dr. Hazen is named as co-inventor on pending patents filed by the Cleveland Clinic Foundation that relate the use of biomarkers, including myeloperoxidase, for inflammatory and cardiovascular diseases. Dr. Hazen is the scientific founder of PrognostiX Inc. Dr. Hazen has received honoraria for educational presentations from Merck, BioSite, Abbott, Pfizer, Lilly, Wyeth, Esperion, GlaxoS-mithKline and Atherogenics. He has served as a consultant for Merck, Pfizer, PrognostiX, Wyeth, Biophysical, and is on the advisory board of PrognostiX.
PY - 2008/5
Y1 - 2008/5
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
UR - http://www.scopus.com/inward/record.url?scp=45349099743&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=45349099743&partnerID=8YFLogxK
U2 - 10.1093/eurheartj/ehn071
DO - 10.1093/eurheartj/ehn071
M3 - Article
C2 - 18339606
AN - SCOPUS:45349099743
SN - 0195-668X
VL - 29
SP - 1096
EP - 1102
JO - European Heart Journal
JF - European Heart Journal
IS - 9
ER -