Proteinase 3 and prognosis of patients with acute myocardial infarction
Résumé
Background A multimarker approach may be useful for risk stratification in AMI patients, particularly utilising pathways that are pathophysiologically distinct. Aim Our aim was to assess the prognostic value of Proteinase 3 in patients post acute myocardial infarction (AMI). We compared the prognostic value of Proteinase 3, an inflammatory marker to an established marker N-terminal pro-B-type natriuretic peptide (NT-proBNP) post-AMI. Method We recruited 900 consecutive post-AMI patients (700 men, age 64.6 ± 12.4 years) in a prospective study with follow-up over 347[0-764] days. Results Plasma Proteinase 3 was significantly higher in patients who died (666.2 [226.8-4035.5] ng/ml, P<0.001) or were readmitted with heart failure (598 [231.6-1803.9] ng/ml, P<0.004) compared to event free survivors (486.9 [29.3-3118.2] ng/ml). Using Cox modelling log10 Proteinase 3 (HR 3.80) and log10NT-proBNP (HR 2.51) were significant independent predictors of death or heart failure. When patients were stratified by plasma NTproBNP (median 1023 pmol/L), Proteinase 3 gave additional predictive value for death or heart failure, in both the patients in whom NTproBNP level was above the median (log rank for trend 12.54, p<0.0004) and those with NTproBNP level below the median (log rank for trend 3.83, p<0.05). Neither marker predicted recurrent AMI. Conclusion This is the first report showing a potential role for the serine protease Proteinase 3 in determining mortality and incidence of heart failure following AMI, independent of established conventional risk factors. Proteinase 3 may represent a clinically useful marker of prognosis after an AMI as part of a multimarker strategy.
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