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.
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U2 - 10.1016/j.ahj.2011.08.017
DO - 10.1016/j.ahj.2011.08.017
M3 - Article
C2 - 22093206
AN - SCOPUS:81255214697
SN - 0002-8703
VL - 162
SP - 893
EP - 899
JO - American heart journal
JF - American heart journal
IS - 5
ER -