Published Online
on October 11, 2004

A more recent version of this article appeared on October 19, 2004

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Submitted on January 8, 2004
Revised on June 16, 2004
Accepted on June 21, 2004

Prognostic Significance of the Long Pentraxin PTX3 in Acute Myocardial Infarction

Roberto Latini MD^*, Aldo P. Maggioni MD, Giuseppe Peri BS, Lucio Gonzini BS, Donata Lucci BS, Paolo Mocarelli MD, Luca Vago MD, Fabio Pasqualini BS, Stefano Signorini MD, Dario Soldateschi BS, Lorenzo Tarli BS, Carlo Schweiger MD, Claudio Fresco MD, Rossana Cecere BS, Gianni Tognoni MD, Alberto Mantovani MD, on behalf of the Lipid Assessment Trial Italian Network (LATIN) Investigators

From the Mario Negri Institute for Pharmacological Research, Milan (R.L., G.P., F.P., A.M.); ANMCO Research Centre, Firenze (A.P.M., L.G., D.L.); Milano-Bicocca University, Department of Laboratory Medicine-Desio Hospital, Desio, Milan (P.M., S.S., R.C.); Department of Cardiac Rehabilitation, Passirana Hospital, Rho-Milano (C.S.); the Diesse-Diagnostica Senese SpA., Monteriggioni, Siena (D.S., L.T.); Institutes of Pathology and General Pathology (A.M.), University of Milan, L. Sacco Hospital, Milan (L.V.); Department of Cardiology, S. Maria della Misericordia Hospital, Udine (C.F.); and Consorzio Mario Negri Sud, S. Maria Imbaro, Chieti (G.T.), Italy.

^* To whom correspondence should be addressed. E-mail: latini{at}marionegri.it.

Background--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 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.

Methods and Results--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 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.

Conclusions--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.

Key words: C-reactive protein • myocardial infarction • natriuretic peptide, brain • troponin

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