title: Usefulness of plasma matrix metalloproteinase-9 level in predicting future coronary revascularization in patients after acute myocardial infarction.
abstract: OBJECTIVE
  This study aims to determine whether plasma levels of matrix metalloproteinases (MMPs) and inflammatory markers can predict the long-term prognosis of coronary revascularization in patients after acute myocardial infarction (AMI).
  
  
  BACKGROUND
  MMPs have been implicated in the development of atherosclerosis and plaque rupture in acute coronary syndrome.
  
  
  METHODS
  Ninety-six consecutive patients (63±11 years) diagnosed with myocardial infarction were enrolled. All patients were followed up for 43±12 months. Plasma levels of MMP-2 and MMP-9 were determined from blood samples collected immediately after hospitalization. Coronary revascularization was defined as having received a percutaneous coronary intervention or a coronary artery bypass graft surgery.
  
  
  RESULTS
  A total of 29 patients (30%) had undergone coronary revascularization during the follow-up period, including 27 percutaneous coronary intervention and two coronary artery bypass graft surgery. The baseline characteristics were similar between groups with or without revascularization. Patients with coronary revascularization had significantly higher MMP-9 levels (P=0.048), but not MMP-2 levels. In addition, a positive correlation was found between circulating MMP-9 level and total cholesterol (r=0.250, P=0.016) and low-density lipoprotein-cholesterol (r=0.284, P=0.009). All patients were divided into a high-MMP-9 group (highest tertile≥1.10 ng/ml) and a low-MMP-9 group (<1.10 ng/ml). The incidence of coronary revascularization was significantly increased in the high-MMP-9 group (P=0.034). In a multivariate Cox regression analysis that included MMP-9 and classical risk factors, the MMP-9 level was an independent predictor of coronary revascularization in patients after AMI (hazard ratio, 2.72; 95% confidence interval, 1.24-5.98; P=0.026).
  
  
  CONCLUSIONS
  Increased plasma levels of MMP-9 but not MMP-2 or inflammatory markers predict future coronary revascularization, and a significant association was observed with MMP-9 and low-density lipoprotein-cholesterol. These findings suggest a pivotal role of MMP-9 in atherothrombosis in AMI patients.
authors.affiliation: Division of Cardiology, Taipei Veterans General Hospital, Taiwan.
authors.forename: Ko-Fan
authors.initials: KF
authors.lastname: Wang
authors.forename: Po-Hsun
authors.initials: PH
authors.lastname: Huang
authors.forename: Chia-Hung
authors.initials: CH
authors.lastname: Chiang
authors.forename: Chien-Yi
authors.initials: CY
authors.lastname: Hsu
authors.forename: Hsin-Bang
authors.initials: HB
authors.lastname: Leu
authors.forename: Jaw-Wen
authors.initials: JW
authors.lastname: Chen
authors.forename: Shing-Jong
authors.initials: SJ
authors.lastname: Lin
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D002784:Cholesterol / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D053208:Kaplan-Meier Estimate; D008297:Male; D020778:Matrix Metalloproteinase 2 / Q000097:blood; D020780:Matrix Metalloproteinase 9 / Q000097:blood*; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000097:blood / Q000201:enzymology* / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000097:blood; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; D008078:Cholesterol, LDL; D018836:Inflammation Mediators; D014409:Tumor Necrosis Factor-alpha; D002097:C-Reactive Protein; D002784:Cholesterol; C522361:MMP2 protein, human; D020778:Matrix Metalloproteinase 2; C579270:MMP9 protein, human; D020780:Matrix Metalloproteinase 9