title: Serum myeloperoxidase level predicts reperfusion in patients with myocardial infarction receiving thrombolytic therapy.
abstract: Polymorphonuclear leukocytes play a central role in all stages of the atherothrombotic inflammatory process. The atherothrombotic activity of polymorphonuclear leukocytes is exerted by mediators such as myeloperoxidase (MPO). Although the role of MPO has been studied with respect to the development of adverse cardiac events in acute coronary syndromes (ACS), the association of this molecule with effectiveness of reperfusion in patients receiving thrombolysis is not yet known. The study population consisted of a total of 158 patients with acute coronary syndromes. Final diagnosis was ST-segment elevation myocardial infarction in 86 patients, 80 of whom received thrombolysis. Blood samples were drawn at presentation of the patients and serum myeloperoxidase levels were measured. Reperfusion was defined in terms of electrocardiographic ST-segment resolution. The serum levels of MPO were found to be correlated with rates of in-hospital adverse events including death (P < 0.001), reinfarction (P < 0.001), recurrent ischemia (P < 0.001), arrhythmias (P < 0.001), clinical heart failure (P < 0.001), and cardiogenic shock (P < 0.001). There was a significant difference in serum MPO levels between subjects with three-vessel disease and two- or one-vessel disease (P < 0.001). Pre-lytic serum high-sensitivity C-reactive protein levels in patients with successful reperfusion were lower than in patients with failed reperfusion (P < 0.001). Analysis of patients with ST segment elevation myocardial infarction receiving thrombolytic therapy revealed that pre-lytic serum MPO levels in patients with successful reperfusion were significantly lower than those of patients with failed reperfusion (P < 0.001). In the present study, serum MPO levels were found to be a strong predictor of response to thrombolytic treatment in patients with ST-segment elevation myocardial infarction. Therefore the level of inflammatory activity in acute coronary syndromes seems to influence the effectiveness of fibrinolysis.
authors.affiliation: Department of Cardiology, Cerrahpasa School of Medicine, Istanbul University, Istanbul 34098, Turkey, karadag@istanbul.edu.tr
authors.forename: Bilgehan
authors.initials: B
authors.lastname: Karadag
authors.forename: Bulent
authors.initials: B
authors.lastname: Vatan
authors.forename: Yalcin
authors.initials: Y
authors.lastname: Hacioglu
authors.forename: Dursun
authors.initials: D
authors.lastname: Duman
authors.forename: Murat
authors.initials: M
authors.lastname: Baskurt
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Keles
authors.forename: Zeki
authors.initials: Z
authors.lastname: Ongen
authors.forename: Vural Ali
authors.initials: VA
authors.lastname: Vural
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications* / Q000188:drug therapy / Q000201:enzymology / Q000401:mortality; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D004562:Electrocardiography; D005260:Female; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000201:enzymology / Q000209:etiology / Q000401:mortality; D009195:Peroxidase / Q000097:blood*; D011237:Predictive Value of Tests; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000401:mortality; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D018836:Inflammation Mediators; D002097:C-Reactive Protein; D009195:Peroxidase