Prognostic significance of the long pentraxin PTX3 in acute myocardial infarction.
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 approximately 7 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.


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 > or =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.
Mario Negri Institute for Pharmacological Research, Milan, Italy. latini@marionegri.it.
Roberto
R
Latini
Aldo P
AP
Maggioni
Giuseppe
G
Peri
Lucio
L
Gonzini
Donata
D
Lucci
Paolo
P
Mocarelli
Luca
L
Vago
Fabio
F
Pasqualini
Stefano
S
Signorini
Dario
D
Soldateschi
Lorenzo
L
Tarli
Carlo
C
Schweiger
Claudio
C
Fresco
Rossana
R
Cecere
Gianni
G
Tognoni
Alberto
A
Mantovani
D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers; D002097:C-Reactive Protein / Q000032:analysis* / Q000737:chemistry; D003402:Creatine Kinase / Q000097:blood; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000150:complications / Q000401:mortality; D017202:Myocardial Ischemia / Q000453:epidemiology; D020097:Natriuretic Peptide, Brain; D009419:Nerve Tissue Proteins / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011379:Prognosis; D011446:Prospective Studies; D020033:Protein Isoforms / Q000097:blood / Q000737:chemistry; D000683:Serum Amyloid P-Component / Q000032:analysis* / Q000737:chemistry; D016896:Treatment Outcome; D020107:Troponin T / Q000097:blood; D000099153:Pentraxins
D015415:Biomarkers; D002097:C-Reactive Protein; D003402:Creatine Kinase; D020097:Natriuretic Peptide, Brain; D009419:Nerve Tissue Proteins; D010446:Peptide Fragments; D020033:Protein Isoforms; D000683:Serum Amyloid P-Component; D020107:Troponin T; D000099153:Pentraxins; C109794:pro-brain natriuretic peptide (1-76)