title: Diagnostic efficacy of myeloperoxidase to identify acute coronary syndrome in subjects with chest pain.
abstract: BACKGROUND
  Early diagnosis of acute coronary syndrome (ACS) is frequently a challenging task.
  
  
  OBJECTIVE
  To assess the role of novel biomarkers to identify ACS.
  
  
  METHODS
  Concentrations of lipids, lipoproteins, oxidized LDL (oxLDL), high-sensitivity C-reactive protein (hsCRP), paraoxonase-1 (PON1), secretory phospholipase A2 (sPLA2), and myeloperoxidase (MPO) were measured in 703 patients (mean age 65.5 ± 11.2 years; 422 men, 281 women) without diabetes mellitus assigned to coronary angiogram. The subjects were divided into three groups: ACS (n = 242), stable angina pectoris (SAP) (n = 242), and normal coronary artery (NCA) (n = 219).
  
  
  RESULTS
  HDL-cholesterol (HDL-C) (P < 0.001) and apolipoproteinA-I concentrations (P < 0.0001) were lowest in subjects with ACS. LDL-C (P = 0.008) and non-HDL (P < 0.0001) were higher in the ACS group than in the SAP group. Leukocyte count (P < 0.0001), oxLDL (P < 0.05), hsCRP (P < 0.001), sPLA2 (P < 0.05), and MPO (P < 0.0001) were highest in the ACS group. In multivariate models, comprising all biomarkers, elevated level of MPO had the best discriminatory power to identify patients with ACS. Receiver-operating characteristic curve with and without MPO comparison differed significantly (P = 0.03 for both ACS versus NCA and ACS versus SAP).
  
  
  CONCLUSIONS
  Our study shows that ACS associates with low HDL-C and biomarkers of oxidative stress and inflammation. The addition of MPO in biomarker panels might improve diagnostic accuracy for ACS.
authors: Heart and Lung Center, Division of Cardiology, Helsinki University Central Hospital, Helsinki, Finland.
authors: Marit
authors: M
authors: Granér
authors: Emmi
authors: E
authors: Tikkanen
authors: Olga
authors: O
authors: Rimpilä
authors: Helena
authors: H
authors: Tikkanen
authors: Samuli
authors: S
authors: Ripatti
authors: Marja-Liisa
authors: ML
authors: Lokki
authors: Markku S
authors: MS
authors: Nieminen
authors: Marja-Riitta
authors: MR
authors: Taskinen
authors: Juha
authors: J
authors: Sinisalo
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood / Q000150:complications* / Q000175:diagnosis*; D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis*; D002637:Chest Pain / Q000097:blood* / Q000209:etiology; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D026502:LDL-Receptor Related Proteins / Q000097:blood; D008297:Male; D026901:Membrane Transport Proteins / Q000097:blood; D008875:Middle Aged; D009195:Peroxidase / Q000097:blood*; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D026502:LDL-Receptor Related Proteins; D026901:Membrane Transport Proteins; D002097:C-Reactive Protein; D009195:Peroxidase