Prognostic significance of the long pentraxin PTX3 in acute myocardial infarction
Prognostic significance of the long pentraxin PTX3 in acute myocardial infarction
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DOI：
10.1161/01.cir.0000145167.30987.2e
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发表时间：
2004-10-19
期刊：
影响因子：
37.8
通讯作者：
Mantovani, A
中科院分区：
文献类型：
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作者：
Latini, R;Maggioni, AP;Mantovani, A
背景-炎症在急性心肌梗死（MI）中具有发病作用.正五聚蛋白-3（PTX 3）是一种长的正五聚蛋白，在炎症刺激下产生，在心脏中高度表达，心肌梗死后约7小时在血浆中达到峰值。本研究的目的是评估PTX 3在MI中的预后价值，与最知名的和临床相关的生物标记物相比，方法和结果-在724例MI和ST段抬高的患者中，PTX 3、C-反应蛋白（CRP）、肌酸激酶（CK）、肌钙蛋白T（TnT）和N-末端脑钠肽前体（NT-proBNP）在入院时（中位数为3小时）和第二天早晨（中位数为症状发作后22小时）进行测定。关于指标事件发生后3个月内发生的结局事件，无事件患者的中位PTX 3值为7.08 ng/mL，死亡患者为16.12 ng/mL，非致死性心力衰竭患者为9.12 ng/mL，非致死性残余缺血患者为6.88 ng/mL（总体P < 0.0001）。包括CRP、CK、TnT和NT-proBNP在内的多变量分析显示，只有年龄>= 70岁（OR，2.11; 95% CI，1.04 - 4.31），入组时Killip分级>1（OR，2.20; 95%CI，1.14至4.25）和PTX 3（> 10.73 ng/mL）（OR，3.55; 95%CI，1.43至8.83）独立预测3个月死亡率。预测存活者死亡和心力衰竭联合终点的生物标志物是PTX 3和NT-proBNP的最高三分位数和CK比值> 6。结论-在ST段抬高的MI患者的代表性当代样本中，急性时相蛋白PTX 3，而不是肝源性短五聚蛋白CRP或其他心脏生物标志物，（NT-proBNP、TnT、CK）预测校正主要危险因素和其他急性期预后标志物后3个月的死亡率。
Background - Inflammation has a pathogenetic role in acute myocardial infarction (MI). Pentraxin-3 (PTX3), a long pentraxin produced in response to inflammatory stimuli and highly expressed in the heart, was shown to peak in plasma approximate to7 hours after MI. The aim of this study was to assess the prognostic value of PTX3 in MI compared with the best- known and clinically relevant biological markers.Methods and Results - In 724 patients with MI and ST elevation, PTX3, C-reactive protein (CRP), creatine kinase (CK), troponin T (TnT), and N-terminal pro-brain natriuretic peptide (NT-proBNP) were assayed at entry, a median of 3 hours, and the following morning, a median of 22 hours from symptom onset. With respect to outcome events occurring over 3 months after the index event, median PTX3 values were 7.08 ng/mL in event-free patients, 16.12 ng/mL in patients who died, 9.12 ng/mL in patients with nonfatal heart failure, and 6.88 ng/mL in patients with nonfatal residual ischemia (overall P < 0.0001). Multivariate analysis including CRP, CK, TnT, and NT-proBNP showed that only age >= 70 years (OR, 2.11; 95% CI, 1.04 to 4.31), Killip class >1 at entry (OR, 2.20; 95% CI, 1.14 to 4.25), and PTX3 ( > 10.73 ng/mL) (OR, 3.55; 95% CI, 1.43 to 8.83) independently predicted 3-month mortality. Biomarkers predicting the combined end point of death and heart failure in survivors were the highest tertile of PTX3 and of NT-proBNP and a CK ratio >6.Conclusions - In a representative contemporary sample of patients with MI with ST elevation, the acute-phase protein PTX3 but not the liver-derived short pentraxin CRP or other cardiac biomarkers (NT-proBNP, TnT, CK) predicted 3-month mortality after adjustment for major risk factors and other acute-phase prognostic markers.