title: Elevated serum neopterin predicts future adverse cardiac events in patients with chronic stable angina pectoris.
abstract: OBJECTIVE
  Serum levels of neopterin, an immune modulator secreted by activated macrophages, are elevated in patients with acute coronary syndromes compared with stable angina patients and control subjects. In unstable angina, serum neopterin levels correlate with the presence of vulnerable coronary stenosis, multiple complex coronary lesions, and patient outcome. The present study assessed the prognostic significance of raised serum neopterin concentrations in patients with stable angina pectoris.
  
  
  RESULTS
  We carried out a 1-year follow-up prospective study in 297 patients with chronic stable chest pain undergoing diagnostic coronary angiography. The primary study endpoint was the composite of non-fatal myocardial infarction, unstable angina, and cardiac death. Fifty-one patients (17.2%) had adverse coronary events during follow-up. Mean serum neopterin levels were significantly higher in patients with events compared with those without (P=0.02). On multiple regression analysis, neopterin levels (P=0.021), severity of coronary artery disease (P=0.009), and a history of previous myocardial infarction (P=0.001) were independent predictors of adverse events.
  
  
  CONCLUSIONS
  Serum neopterin is an independent predictor of major adverse coronary events in patients with chronic stable angina pectoris. This marker of macrophage activation may be useful for risk stratification in patients with chronic stable angina.
authors.affiliation: Department of Cardiological Sciences, St George's Hospital Medical School, Cranmer Terrace, London SW17 0RE, UK.
authors.forename: Pablo
authors.initials: P
authors.lastname: Avanzas
authors.forename: Ramon
authors.initials: R
authors.lastname: Arroyo-Espliguero
authors.forename: Juan
authors.initials: J
authors.lastname: Quiles
authors.forename: Debashis
authors.initials: D
authors.lastname: Roy
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Kaski
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000097:blood* / Q000401:mortality; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D002908:Chronic Disease; D003324:Coronary Artery Disease / Q000097:blood / Q000209:etiology; D005260:Female; D006801:Humans; D008262:Macrophage Activation / Q000502:physiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000401:mortality; D019798:Neopterin / Q000097:blood*; D011379:Prognosis; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D018487:Ventricular Dysfunction, Left / Q000097:blood / Q000209:etiology
chemical_list: D015415:Biomarkers; D019798:Neopterin; D002097:C-Reactive Protein