Abstract
Background. Myocardial inflammation following acute ischemic injury has been linked to poor cardiac remodeling and heart failure. Many studies have linked myeloperoxidase (MPO), a neutrophil and inflammatory marker, to cardiac inflammation in the setting of acute coronary syndrome (ACS). However, the prognostic role of MPO for adverse clinical outcomes in ACS patients has not been well established. Methods. MEDLINE and Cochrane databases were searched for studies from 1975 to March 2018 that investigated the prognostic value of serum MPO in ACS patients. Studies which have dichotomized patients into a high MPO group and a low MPO group reported clinical outcomes accordingly and followed up patients for at least 30 days to be eligible for enrollment. Data were analyzed using random-effects model. Sensitivity analyses were conducted for quality control. Results. Our meta-analysis included 13 studies with 9090 subjects and a median follow-up of 11.4 months. High MPO level significantly predicted mortality (odds ratio (OR) 2.03; 95% confidence interval (CI): 1.40-2.94; ), whereas it was not significantly predictive of major adverse cardiac events and recurrent myocardial infarction (MI) (OR 1.28; CI: 0.92-1.77, and OR 1.23; CI: 0.96-1.58, , respectively). Hypertension, diabetes mellitus, and age did not affect the prognostic value of MPO for clinical outcomes, whereas female gender and smoking status have a strong influence on the prognostic value of MPO in terms of mortality and recurrent MI (metaregression coefficient -8.616: 95% CI -14.59 to -2.633, and 4.88: 95% CI 0.756 to 9.0133, , respectively). Conclusions. Our meta-analysis suggests that high MPO levels are associated with the risk of mortality and that MPO can be incorporated in risk stratification models that guide therapy of high-risk ACS patients.
Document Type
Review
Publication Date
6-25-2019
Digital Object Identifier (DOI)
https://doi.org/10.1155/2019/2872607
Funding Information
Dr. Abdel-Latif is supported by the University of Kentucky COBRE Early Career Program (P20 GM103527) and the NIH Grant R01 HL124266.
Related Content
Supplemental Table 1: (A) MEDLINE search strategy. (B) Scopus search strategy. Supplemental Table 2: the definition of major adverse cardiac events of the included studies in the meta-analysis. Supplemental Table 3: assessment of the quality of the included studies using the Newcastle-Ottawa quality assessment scale. Supplemental Figure 1: metaregression for risk factors of mortality. X axis represents the observed effect size of studies. Y is the metaregression coefficient. Age (Y = -0.12; P = 0.32). Female (-8.61; P = 0.0048). ACS (Y = -0.071; P = 0.94). DM (Y = 3.522; P = 0.32). Hypertension (Y = -0.20; P = 0.911). Smoking (Y = 1.44; P = 0.55). Supplemental Figure 2: metaregression for risk factors of major adverse cardiac events. X axis represents the observed effect size of studies. Y is the metaregression coefficient. Age (Y = -0.112; P = 0.28). Female (-3.15; P = 0.301). ACS (Y = -0.22; P = 0.897). DM (Y = -0.353; P = 0.89). Hypertension (Y = -0.74; P = 0.785). Smoking (Y = 2.04; P = 0.28). Supplemental Figure 3: metaregression for risk factors of recurrent myocardial infraction. X axis represents the observed effect size of studies. Y is the metaregression coefficient. Age (Y = -0.03; P = 0.68). Female (-2.23; P = 0.06). ACS (Y = -0.11; P = 0.89). DM (Y = 2.0; P = 0.286). Hypertension (Y = 1.13; P = 0.37). Smoking (Y = 4.8; P = 0.204). Supplemental Figure 4: forest plot displays sensitivity analysis using the one-study-removed method. High myeloperoxidase is significantly associated with mortality (odds ratio 2.040; 95% confidence interval (CI): 1.405-2.960, P = 0.000). High MPO showed a trend for developing major adverse cardiac events (odds ratio 1.421; 95% confidence interval (CI): 1.010-1.999, P = 0.044) and recurrent MI (odds ratio 1.241; 95% confidence interval (CI): 0.996-1.545, P = 0.054). Supplemental Figure 5: forest plot displays cumulative meta-analysis. High myeloperoxidase is significantly associated with mortality (odds ratio 2.040; 95% confidence interval (CI): 1.405-2.960, P = 0.000). High MPO showed a trend for developing major adverse cardiac events (odds ratio 1.421; 95% confidence interval (CI): 1.010-1.999, P = 0.044) and recurrent MI (odds ratio 1.241; 95% confidence interval (CI): 0.996-1.545, P = 0.054). Supplemental Figure 6: funnel plot of all studies included in the meta-analysis. The standard error (SE) of the log odds ratio of each study was plotted against the odds ratio for mortality. No skewed distribution was observed, suggesting no publication bias. Supplemental Figure 7: funnel plot of all studies included in the meta-analysis. The standard error (SE) of the log odds ratio of each study was plotted against the odds ratio for major adverse cardiac events. No skewed distribution was observed, suggesting no publication bias. Supplemental Figure 8: funnel plot of all studies included in the meta-analysis. The standard error (SE) of the log odds ratio of each study was plotted against the odds ratio for recurrent myocardial infraction. No skewed distribution was observed, suggesting no publication bias. (Supplementary Materials)
Repository Citation
Kolodziej, Andrew R.; Abo-Aly, Mohamed; Elsawalhy, Eman; Campbell, Charles; Ziada, Khaled M.; and Abdel-Latif, Ahmed K., "Prognostic Role of Elevated Myeloperoxidase in Patients with Acute Coronary Syndrome: A Systemic Review and Meta-Analysis" (2019). Gill Heart & Vascular Institute Faculty Publications. 20.
https://uknowledge.uky.edu/heart_facpub/20
Supplementary Materials
Notes/Citation Information
Published in Mediators of Inflammation, v. 2019, article ID 2872607, p. 1-9.
Copyright © 2019 Andrew R. Kolodziej et al.
This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.