Prognostic significance of the long pentraxin PTX3 in acute myocardial infarction

• Published in: Circulation (New York, N.Y.) Vol. 110; no. 16; pp. 2349 - 2354
• Main Authors: LATINI, Roberto, MAGGIONI, Aldo P, TARLI, Lorenzo, SCHWEIGER, Carlo, FRESCO, Claudio, CECERE, Rossana, TOGNONI, Gianni, MANTOVANI, Alberto, PERI, Giuseppe, GONZINI, Lucio, LUCCI, Donata, MOCARELLI, Paolo, VAGO, Luca, PASQUALINI, Fabio, SIGNORINI, Stefano, SOLDATESCHI, Dario
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 19.10.2004
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; Biomarkers; Blood and lymphatic vessels; C-Reactive Protein - analysis; C-Reactive Protein - chemistry; Cardiology. Vascular system; Coronary heart disease; Creatine Kinase - blood; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Electrocardiography; Female; Follow-Up Studies; Heart; Heart Failure - blood; Heart Failure - epidemiology; Heart Failure - etiology; Humans; Italy - epidemiology; Male; Medical sciences; Middle Aged; Myocardial Infarction - blood; Myocardial Infarction - complications; Myocardial Infarction - mortality; Myocardial Ischemia - epidemiology; Natriuretic Peptide, Brain; Nerve Tissue Proteins - blood; Neurology; Peptide Fragments - blood; Prognosis; Prospective Studies; Protein Isoforms - blood; Protein Isoforms - chemistry; Serum Amyloid P-Component - analysis; Serum Amyloid P-Component - chemistry; Treatment Outcome; Troponin T - blood; Vascular diseases and vascular malformations of the nervous system; Italy; Myocardial infarction; Brain natriuretic peptide; Troponin; Prognosis; C-reactive protein; Heart disease; Cardiovascular disease; C reactive protein; Myocardial disease; natriuretic peptide, brain
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/01.cir.0000145167.30987.2e

Inflammation has a pathogenetic role in acute myocardial infarction (MI). Pentraxin-3 (PTX3), a long pentraxin produced in response to inflammatory stimuli and highly expressed in the heart, was shown to peak in plasma approximately 7 hours after MI. The aim of this study was to assess the prognostic value of PTX3 in MI compared with the best-known and clinically relevant biological markers. In 724 patients with MI and ST elevation, PTX3, C-reactive protein (CRP), creatine kinase (CK), troponin T (TnT), and N-terminal pro-brain natriuretic peptide (NT-proBNP) were assayed at entry, a median of 3 hours, and the following morning, a median of 22 hours from symptom onset. With respect to outcome events occurring over 3 months after the index event, median PTX3 values were 7.08 ng/mL in event-free patients, 16.12 ng/mL in patients who died, 9.12 ng/mL in patients with nonfatal heart failure, and 6.88 ng/mL in patients with nonfatal residual ischemia (overall P<0.0001). Multivariate analysis including CRP, CK, TnT, and NT-proBNP showed that only age > or =70 years (OR, 2.11; 95% CI, 1.04 to 4.31), Killip class >1 at entry (OR, 2.20; 95% CI, 1.14 to 4.25), and PTX3 (>10.73 ng/mL) (OR, 3.55; 95% CI, 1.43 to 8.83) independently predicted 3-month mortality. Biomarkers predicting the combined end point of death and heart failure in survivors were the highest tertile of PTX3 and of NT-proBNP and a CK ratio >6. In a representative contemporary sample of patients with MI with ST elevation, the acute-phase protein PTX3 but not the liver-derived short pentraxin CRP or other cardiac biomarkers (NT-proBNP, TnT, CK) predicted 3-month mortality after adjustment for major risk factors and other acute-phase prognostic markers.