The Diagnostic and Prognostic Performance of Myeloperoxidase Plasma Levels as Compared to Sensitive Troponins in Patients Admitted With Acute Onset Chest Pain

Study Questions:

How useful are plasma myeloperoxidase (MPO) levels compared to troponin (TN) levels in managing patients with chest pain?

Methods:

A total of 1,818 consecutive patients admitted for chest pain underwent measurement of MPO, sensitive troponin I (sTNI), and B-type natriuretic peptide (BNP) plasma levels at admission, 3 hours, and 6 hours thereafter.

Results:

Baseline MPO levels were elevated in patients with acute myocardial infarction (AMI) compared to patients with noncoronary chest pain. For all time points, accuracy of MPO was inferior to sTNI for predicting AMI. The sensitivity of MPO to diagnose AMI at presentation was 73.5% compared to 90.7% for sTNI, and the specificity of MPO was 45.5%, as opposed to 90.2%. BNP levels also failed to demonstrate independent diagnostic information. MPO and BNP were both predictive for increased risk of adverse events at 30 days and 6 months, whereas their predictive value was weakened after covariate adjustment.

Conclusions:

The authors concluded that MPO and BNP fail to provide incremental information for patients with acute onset chest pain when added to sTN.

Perspective:

MPO, BNP, and sTNI are biomarkers that each reflect different cellular events. While sensitive cardiac TNs are widely accepted as being sensitive and specific for myocyte injury, the ability of MPO and BNP to predict cardiac sources of chest pain has been controversial. This study confirms in prospective fashion that sTNI is superior to MPO and BNP in the triage of patients presenting with chest pain. However, because MPO and BNP may reflect the extent of inflammation and hemodynamic stress, they may be useful in predicting long-term prognosis. The utility of these markers in guiding post-MI management will require further study.

Keywords: Myocardial Infarction, Biological Markers, Chest Pain, Sensitivity and Specificity, Peroxidase, Troponin, Natriuretic Peptide, Brain


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