title: Markers of plaque instability in the early diagnosis and risk stratification of acute myocardial infarction.
abstract: BACKGROUND
  Plaque erosion and plaque rupture occur early in the pathophysiology of acute myocardial infarction (AMI). We hypothesized that markers of plaque instability might be useful in the early diagnosis and risk stratification of AMI.
  
  
  METHODS
  In this multicenter study, we examined 4 markers of plaque instability, myeloperoxidase (MPO), myeloid-related protein 8/14 (MRP-8/14), pregnancy-associated plasma protein-A (PAPP-A), and C-reactive protein (CRP) in 398 consecutive patients presenting to the emergency department with acute chest pain and compared them to normal and high-sensitivity cardiac troponin T (cTnT and hs-cTnT). The final diagnosis was adjudicated by 2 independent cardiologists. Primary prognostic end point was death during a median follow-up of 27 months.
  
  
  RESULTS
  The adjudicated final diagnosis was AMI in 76 patients (19%). At emergency department presentation, concentrations of all 4 biomarkers of plaque instability were significantly higher in patients with AMI than in patients with other diagnoses. However, their diagnostic accuracy as quantified by the area under the ROC curve (AUC) was low (MPO 0.63, MRP-8/14 0.65, PAPP-A 0.62, CRP 0.59) and inferior to both normal and high-sensitivity cardiac troponin T (cTnT 0.88, hs-cTnT 0.96; P<0.001 for all comparisons). Thirty-nine patients (10%) died during follow-up. Concentrations of MPO, MRP-8/14, and CRP were higher in nonsurvivors than in survivors and predicted all-cause mortality with moderate accuracy.
  
  
  CONCLUSIONS
  Biomarkers of plaque instability do not seem helpful in the early diagnosis of AMI but may provide some incremental value in the risk stratification of patients with acute chest pain.
authors: Department of Internal Medicine, University Hospital Basel, Basel, Switzerland.
authors: Nora
authors: N
authors: Schaub
authors: Tobias
authors: T
authors: Reichlin
authors: Christophe
authors: C
authors: Meune
authors: Raphael
authors: R
authors: Twerenbold
authors: Philip
authors: P
authors: Haaf
authors: Willibald
authors: W
authors: Hochholzer
authors: Nadine
authors: N
authors: Niederhauser
authors: Piet
authors: P
authors: Bosshard
authors: Claudia
authors: C
authors: Stelzig
authors: Michael
authors: M
authors: Freese
authors: Miriam
authors: M
authors: Reiter
authors: Joachim
authors: J
authors: Gea
authors: Andreas
authors: A
authors: Buser
authors: Alexandre
authors: A
authors: Mebazaa
authors: Stefan
authors: S
authors: Osswald
authors: Christian
authors: C
authors: Mueller
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood*; D002097:C-Reactive Protein / Q000032:analysis; D040501:Calgranulin A / Q000097:blood; D040502:Calgranulin B / Q000097:blood; D002637:Chest Pain / Q000097:blood; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000209:etiology; D009195:Peroxidase / Q000097:blood; D058226:Plaque, Atherosclerotic / Q000150:complications / Q000175:diagnosis*; D011266:Pregnancy-Associated Plasma Protein-A / Q000032:analysis; D011379:Prognosis; D012372:ROC Curve; D018570:Risk Assessment; D020107:Troponin T / Q000097:blood
chemical_list: D015415:Biomarkers; D040501:Calgranulin A; D040502:Calgranulin B; D020107:Troponin T; D002097:C-Reactive Protein; D009195:Peroxidase; D011266:Pregnancy-Associated Plasma Protein-A