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Powerful New Prognostic Markers in Patients with Chest Pain

Myeloperoxidase and glutathione peroxidase 1 levels were independent predictors of adverse coronary events.

In recent years, new blood tests, such as those for C-reactive protein (CRP) and homocysteine, that predict the presence of coronary artery disease and coronary outcomes have entered clinical practice. In 2 studies, researchers have evaluated 2 new markers, with impressive results.

A team from Cleveland Clinic evaluated blood levels of a marker of activated leukocytes, myeloperoxidase (MP), in 604 sequential patients with chest pain in an emergency department. MP is a leukocyte enzyme that concentrates in ruptured plaques. After adjustment for other risk factors, elevated levels of MP were highly predictive of adverse coronary outcomes (myocardial infarction, revascularization, or death) within 30 days or 6 months. MP level was a more accurate predictor than were levels of CRP or troponin T; MP level also was a powerful predictor of short-term adverse outcomes among patients with persistently negative troponin T tests, whereas CRP was not.

A German team evaluated another marker, glutathione peroxidase 1 (GP1), which is a powerful antioxidant that is present in atherosclerotic plaques. A total of 636 patients with suspected coronary artery disease were followed for a median of 4.7 years. Higher baseline levels of GP1 were associated with lower rates of cardiovascular events, even after adjustment for other risk factors (hazard ratio, 0.29 for highest vs. lowest GP1 quartiles). Blood markers that were associated significantly with adverse outcomes were high levels of interleukin-6, high levels of homocysteine, and low levels of GP1. Although CRP level had independent predictive power, it was not as strong a predictor as the other factors.

Comment: These findings indicate dynamic movement in the field of rapid diagnostic markers for coronary risk. Although none of these blood tests was compared directly to coronary imaging studies, these results suggest that simple screening blood tests can provide as much predictive information as can more expensive or invasive studies, such as exercise testing, computed tomography, or magnetic resonance imaging.

— Anthony L. Komaroff, MD

Published in Journal Watch General Medicine November 25, 2003

Citation(s):

Brennan M-L et al. Prognostic value of myeloperoxidase in patients with chest pain. N Engl J Med 2003 Oct 23; 349:1595-604.

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• Medline abstract (Free)

Blankenberg S et al. Glutathione peroxidase 1 activity and cardiovascular events in patients with coronary artery disease. N Engl J Med 2003 Oct 23; 349:1605-13.

• Original article (Subscription may be required)
• Medline abstract (Free)