Myeloperoxidase and C-Reactive Protein Have Combined Utility for Long-Term Prediction of Cardiovascular Mortality After Coronary Angiography
Myeloperoxidase and C-Reactive Protein Have Combined Utility for Long-Term Prediction of Cardiovascular Mortality After Coronary Angiography
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DOI：
10.1016/j.jacc.2009.11.050
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发表时间：
2010-03-16
影响因子：
24
通讯作者：
Hill, John S.
中科院分区：
文献类型：
--
作者：
Heslop, Claire L.;Frohlich, Jiri J.;Hill, John S.
目的评价氧化应激生物标志物预测选择性冠状动脉造影患者心血管死亡率的相对价值和综合价值。背景氧化应激参与心血管疾病的各个阶段，从脂蛋白修饰到斑块破裂，氧化应激生物标志物可预测冠状动脉疾病（CAD）的发展。氧化应激生物标志物值得研究，因为它们可能提供长期心血管风险预测的价值。方法在885例选择性冠状动脉造影患者的前瞻性队列中测量髓过氧化物酶（MPO）、硝基酪氨酸、氧化低密度脂蛋白和抗氧化能力，随访心血管死亡率>13年。与MPO水平最低的患者相比，MPO水平最高的三分位数患者预测心血管死亡风险为2.4倍（95%置信区间[CI]：1.47 - 2.98）。MPO还改善了风险模型识别和患者风险类别分类。多种氧化应激生物标志物的升高预测死亡风险增加;然而，最强的风险预测是通过评估MPO和C反应蛋白（CRP）一起实现的。MPO或CRP升高患者的心血管死亡风险是仅升高标志物患者的5.3倍（95%CI：1.86 - 14.9），MPO和CRP均升高患者的风险是仅升高标志物患者的4.3倍（95%CI：2.26 - 8.31）。这些结果仍然显着调整心血管危险因素和基线疾病burst.Conclusions MPO准确预测冠状动脉造影患者的心血管死亡风险。将MPO和CRP一起考虑可能会改善长期风险评估和CAD患者结局。（J Am科尔心脏病学杂志2010; 55：1102-9）（C）美国心脏病学会基金会2010年
Objectives We evaluated the relative and combined value of oxidative stress biomarkers for predicting cardiovascular mortality in patients undergoing selective coronary angiography.Background Oxidative stress participates in all stages of cardiovascular disease, from lipoprotein modification to plaque rupture, and biomarkers of oxidative stress predict development of coronary artery disease (CAD). Oxidative stress biomarkers merit investigation for the value they may offer for long-term cardiovascular risk prediction.Methods Myeloperoxidase (MPO), nitrotyrosine, oxidized low-density lipoprotein, and antioxidant capacity were measured in a prospective cohort of 885 selective coronary angiography patients followed up for >13 years for cardiovascular mortality.Results MPO independently predicted CAD, and top tertile MPO levels predicted a 2.4-fold risk of cardiovascular mortality (95% confidence interval [CI]: 1.47 to 2.98), compared with patients with lowest tertile MPO levels. MPO also improved risk model discrimination and patient risk category classification. Elevations in multiple oxidative stress biomarkers predicted increased mortality risk; however, the strongest risk prediction was achieved by assessing MPO and C-reactive protein (CRP) together. Patients with either MPO or CRP elevated had 5.3-fold higher cardiovascular mortality risk (95% CI: 1.86 to 14.9), and patients with high levels of both MPO and CRP had a 4.3-fold risk compared with patients with only elevated marker (95% CI: 2.26 to 8.31). These results remained significant with adjustment for cardiovascular risk factors and baseline disease burden.Conclusions MPO accurately predicted cardiovascular mortality risk in coronary angiography patients. Considering MPO and CRP together may improve long-term risk assessment and CAD patient outcomes. (J Am Coll Cardiol 2010; 55: 1102-9) (C) 2010 by the American College of Cardiology Foundation