Published online before print October 11, 2004, doi: 10.1161/01.CIR.0000145167.30987.2E
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(Circulation. 2004;110:2349-2354.)
© 2004 American Heart Association, Inc.
Coronary Heart Disease |
Prognostic Significance of the Long Pentraxin PTX3 in Acute Myocardial Infarction
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.
Correspondence to Roberto Latini, Istituto di Ricerche Farmacologiche "Mario Negri," Via Eritrea, 62, 20157 Milano, Italy. E-mail latini{at}marionegri.it
Received January 8, 2004; de novo received April 19, 2004; revision received June 16, 2004; accepted June 21, 2004.
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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