Matrix Metalloproteinase-9 as a Marker for Plaque Rupture and a Predictor of Adverse Clinical Outcome in Patients with Acute Coronary Syndrome: An Optical Coherence Tomography Study.
OBJECTIVE
The present study sought to clarify the relationship between matrix metalloproteinase-9 (MMP-9) levels and plaque morphology demonstrated by optical coherence tomography (OCT), and to examine their prognostic impacts in patients with acute coronary syndrome (ACS).


METHODS
MMP-9 levels were measured for patients with ACS (n = 249). Among 249 patients, 120 with evaluable OCT images were categorized into patients with ruptured plaques (n = 65) and those with nonruptured plaques (n = 55) on the basis of culprit lesion plaque morphology demonstrated by OCT.


RESULTS
MMP-9 levels on admission were significantly higher in the rupture group than in the nonrupture group (p = 0.029). Although creatine kinase-MB (CK-MB) on admission was comparable between the groups, peak CK-MB was higher in the rupture group than in the nonrupture group (p < 0.001). By receiver operating characteristic curve analysis, the optimal cut-off value of MMP-9 to detect ruptured plaques was 65.5 ng/ml (p = 0.029). There was a nonstatistically significant trend toward increased cardiac death at 2 years (5.9 vs. 1.0%, p = 0.059) in patients with high MMP-9 (≥65.5 ng/ml) compared to those with low MMP-9 (<65.5 ng/ml).


CONCLUSIONS
MMP-9 can differentiate ACS with ruptured plaques from nonruptured plaques, and MMP-9 may be a valuable predictor of long-term cardiac mortality in patients with ACS reflecting plaque rupture.
Intensive Care Unit, Nippon Medical School, Chiba Hokusoh Hospital, Chiba, Japan.
Nobuaki
N
Kobayashi
Masamichi
M
Takano
Noritake
N
Hata
Noriaki
N
Kume
Masafumi
M
Tsurumi
Akihiro
A
Shirakabe
Hirotake
H
Okazaki
Junsuke
J
Shibuya
Reiko
R
Shiomura
Suguru
S
Nishigoori
Yoshihiko
Y
Seino
Wataru
W
Shimizu
D054058:Acute Coronary Syndrome / Q000097:blood / Q000175:diagnosis*; D000368:Aged; D015415:Biomarkers / Q000097:blood; D006328:Cardiac Catheterization; D052279:Creatine Kinase, MB Form / Q000097:blood; D005260:Female; D006801:Humans; D008297:Male; D020780:Matrix Metalloproteinase 9 / Q000097:blood*; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000175:diagnosis* / Q000000981:diagnostic imaging; D011379:Prognosis; D012372:ROC Curve; D012422:Rupture, Spontaneous / Q000000981:diagnostic imaging; D041623:Tomography, Optical Coherence
D015415:Biomarkers; D052279:Creatine Kinase, MB Form; D020780:Matrix Metalloproteinase 9