Abstract
Aim of this study was to evaluate the role of Myeloperoxidase (MPO) and high sensitive Troponin T in the early diagnosis of acute coronary syndrome (ACS). This was a cross sectional study that comprised of 120 individuals of which 75 were cases and 45 healthy controls. On the basis of clinical history and 12 lead electrocardiogram initial diagnosis of ACS was made in the cases. MPO and high sensitive Troponin T (hs-cTnT) was measured in all the individuals. Levels of MPO were significantly higher in patients of ACS as compared to those in control group [medians: 15.40 (95 % CI 11.06–20.84) vs 5.84 (95 % CI 5.50–6.44)]. By taking the cut off as >11.87 U/mL for MPO, its sensitivity was 87 % (95 % CI 73.7–95.1), specificity was 97.3 % (95 % CI 90.6–99.7), positive predictive value was 94.6 % and negative predictive value was 92.6 %. Positive likelihood ratio was 33.0 while negative likelihood ratio was 0.13, whereas the corresponding values in case of hs-cTnT were 95.6 % (95 % CI 85.2–99.5), 61.3 % (95 % CI 49.5–72.6), 59.7 %, 95.8 %, 2.47 and 0.07 by taking cut off as >14 pg/ml. The area under the ROC curves (AUC) of MPO and hscTnT at 0–6 h were 0.971 (95 % CI 0.92–0.99, P < 0.001) and 0.797 (95 % CI 0.71–0.86, P < 0.001) respectively. The logistic model combining the two markers yielded sensitivity, specificity, positive predictive value and negative predictive value of 95.7, 97.3, 98.2 and 93.7 % respectively. It was concluded that MPO and hs-cTnT may be useful tools for risk stratification of ACS and can be used together with better accuracy in the early diagnosis of ACS.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Abbreviations
- MPO:
-
Myeloperoxidase
- hs-cTnT:
-
High sensitivity Troponin T
- ACS:
-
Acute coronary syndrome
References
Thygesen K, Alpert JS, White HD, Jaffe AS, Apple FS, Galvani M, et al. Joint ESC/ACCF/AHA/WHF Task Force for universal definition of myocardial infarction. Third universal definition of myocardial infarction. JACC. 2012;60(16):1581–98.
Apple FS. A new season for cardiac troponin assays: it’s time to keep a scorecard. Clin Chem. 2009;55:1303–6.
Braunwald E, Antman EM, Beasley JW, Califf RM, Cheitlin MD, Hochman JS, et al. ACC/AHA 2002 guideline update for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction—summary article: a report of the American College of Cardiology/American Heart Association task force on practice guidelines (Committee on the Management of Patients With Unstable Angina). J Am Coll Cardiol. 2002;40(7):1366–74.
Chen C, Liu J, Hua D, Ma L, Lai T, Fallon JT, et al. Impact of delayed reperfusion of myocardial hibernation on myocardial ultrastructure and function and their recoveries after reperfusion in a pig model of myocardial hibernation. Cardiovasc Pathol. 2000;9(2):67–84.
Apple F, Jaffe A. Cardiac functions: chapter 44. In: Burtis CA, Ashwood ER, Bruns DE, editors. Tietz textbook of clinical chemistry and molecular diagnostics. 4th ed. St.Louis: WB Saunders, Elsevier Inc. 2006. p. 1461–6.
Libby P, Ridker PM, Maseri A. Inflammation and atherosclerosis. Circulation. 2002;105:1135–43.
Buffon A, Biasucci LM, Liuzzo G, D’onofrio G, Crea F, Maseri A. Widespread coronary inflammation in unstable angina. N Engl J Med. 2002;347:5–12.
Klebanoff SJ. Myeloperoxidase. Proc Assoc Am Physicians. 1999;111:383–9.
Mocatta TJ, Pilbrow AP, Cameron VA, Senthilmohan R, Frampton C, Richards M, et al. Plasma concentrations of myeloperoxidase predict mortality after myocardial infarction. J Am Coll Cardiol. 2007;49:1993–2000.
Morrow DA, Sabatine MS, Brennan ML, de Lemos JA, Murphy SA, Ruff CT, et al. Concurrent evaluation of novel cardiac biomarkers in acute coronary syndrome: myeloperoxidase and soluble CD40 ligand and the risk of recurrent ischaemic events in TACTICS-TIMI 18. Eur Heart J. 2008;29(9):1096–102.
Khan SQ, Kelly D, Quinn P, Davies JE, Ng LL. Myeloperoxidase aids prognostication together with N-terminal pro-B-type natriuretic peptide in high-risk patients with acute ST elevation myocardial infarction. Heart. 2007;93(7):826–31.
Peacock WF, Nagurney J, Birkhahn R, Singer A, Shapiro N, Hollander J, et al. Myeloperoxidase in the diagnosis of acute coronary syndromes: the importance of spectrum. Am Heart J. 2011;162(5):893–9.
Meuwese MC, Stroes SG, Hazen SL, Van Miert JN, Kuivenhoven JA, Schaub RG, et al. Serum myeloperoxidase levels are associated with the future risk of coronary artery disease in apparently healthy individuals. J Am Coll Cardiol. 2007;50(2):159–67.
Cavusoglu E, Ruwende C, Eng C, Chopra V, Yanamadala S, Clark LT, et al. Usefulness of baseline plasma myeloperoxidase levels as an independent predictor of myocardial infarction at two years in patients presenting with acute coronary syndrome. Am J Cardiol. 2007;99(10):1364–8.
Li SH, Xing YW, Li ZZ, Bai SG, Wang J. Clinical implications of relationship between myeloperoxidase and acute coronary syndromes. Zhonghua xin xue Guan Bing Za Zhi. 2007;35(3):241–4.
Reichlin T, Hochholzer W, Bassetti S, Steuer S, Stelzig C, Hartwiger S, et al. Early diagnosis of myocardial infarction with sensitive cardiac troponin assays. N Engl J Med. 2009;361:858–67.
Alhashemi JA. Diagnostic accuracy of a bedside qualitative immunochromatographic test for acute myocardial infarction. Am J Emerg Med. 2006;24:149–55.
Conflict of interest
The authors do not have any conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Mehta, M.D., Marwah, S.A., Ghosh, S. et al. A Synergistic Role of Myeloperoxidase and High Sensitivity Troponin T in the Early Diagnosis of Acute Coronary Syndrome. Ind J Clin Biochem 31, 75–80 (2016). https://doi.org/10.1007/s12291-015-0490-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12291-015-0490-4