Myeloperoxidase predicts 12-month heart failure risk after ST-elevation myocardial infarction treated with percutaneous coronary intervention (PCI)
I Rodionova, N A T A L Y Tytarenko, A L L A Kobets, B O R Y S Shelest, Y A N A SamburgAbstract
Background
Myeloperoxidase (MPO) is a marker of inflammation and oxidative stress implicated in endothelial dysfunction and adverse post-infarction remodelling. Early identification of patients at risk of subsequent heart failure (HF) after ST-elevation myocardial infarction (STEMI) remains clinically relevant. The aim of the study was to determine whether MPO measured in the acute phase of STEMI predicts 12-month adverse outcomes with a focus on post-STEMI HF risk.
Methods
We studied 131 patients with STEMI treated with primary percutaneous coronary intervention and without clinical signs of HF at baseline. MPO was measured on day 1 of hospitalisation (enzyme-linked immunosorbent assay). The 12-month composite endpoint included non-fatal recurrent myocardial infarction, new-onset or worsening HF, and all-cause death. Discrimination was evaluated by receiver operating characteristic analysis to identify an MPO threshold. Multivariable logistic regression assessed the association between MPO and the composite endpoint adjusting for age, sex, left ventricular ejection fraction, estimated glomerular filtration rate, and peak troponin (or creatine kinase-MB).
Results
An MPO threshold of greater than 126.5 ng/mL predicted the composite endpoint with 73.3% sensitivity and 78.4% specificity (area under the curve 0.762; 95% confidence interval (CI) 0.648 to 0.861; p<0.001). During follow-up, 15 patients (15.6%) reached the composite endpoint. MPO greater than 126.5 ng/mL was independently associated with higher risk of adverse outcomes (odds ratio 3.14; 95% CI 1.11 to 8.90; p=0.031).
Conclusions
In patients with STEMI undergoing primary revascularisation and without HF at presentation, elevated acute-phase MPO identifies increased 12-month risk of adverse outcomes, including new-onset or worsening HF. MPO may support early post-STEMI risk stratification to guide intensified follow-up focused on HF prevention.