Matrix Metalloproteinase-2 predicts mortality in patients with acute coronary syndrome.
Résumé
Aims To investigate the predictive value of MMP-2, -3 and -9 levels in patients with acute coronary syndrome for death, readmission with heart failure (HF) or recurrent myocardial infarction (MI) and compare them to established markers N-terminal pro-B-type natriuretic peptide (NTproBNP) and GRACE score. Methods and Results A single blood test was taken 4 days after admission in 1024 consecutive patients with AMI with end points observed over 519[134-1059](median[range]) days. MMP-2 and MMP-3 were raised in patients who died (n=111) compared to survivors (p<0.006 and p=0.01 respectively) but similar in patients with HF (n=106) or MI (n=138). MMP-9 levels were similar across study end points. Using Cox proportional hazards modelling MMP-2 demonstrated independent prediction of death (HR 6.60 p=0.001) along with NTproBNP (HR 4.62 p<0.001) and GRACE score (HR 1.03 p<0.001) but MMP-3 or -9 or log10Troponin I did not. For 1 year mortality the ROC-AUC's were 0.60 and 0.58 for MMP-2 and MMP-3 respectively compared to 0.82 for NT-proBNP and 0.84 for GRACE score (all p<0.001). Kaplan-Meier analysis revealed MMP-2 levels in the top quartile were associated with higher mortality rates (log rank 12.49 p=0.006). On univariate analysis MMP-2 and -3 showed a weak association with HF readmission which was lost after adjustment for clinical factors. None of the MMPs tested predicted MI. Conclusions This is the first single centre study that identifies MMP2 as an independent predictor of all cause mortality post ACS however, NT proBNP and the GRACE Score are superior for risk stratification in this cohort.
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