Abstract 19107: Serum Myeloperoxidase/Paraoxonase 1 Ratio Is an Independent Predictor for Repeat Revascularization After Percutaneous Coronary Intervention
There is growing recognition that not only the circulating quantity but the functional quality of high-density lipoprotein (HDL) is important for prevention of coronary artery disease (CAD). However, there are no established clinical methods to estimate the HDL quality. Anti-atherogenic HDL particles undergo oxidation by myeloperoxidase (MPO) and become “dysfunctional”. In contrast, paraoxonase 1 (PON1), HDL associated lipolactonase, provides the anti-oxidant property. We assessed whether measurements of serum MPO and PON1 contributes to CAD risk stratification.
Methods and Results: A total of 107 patients hospitalized for follow-up coronary angiography 6-month after percutaneous coronary intervention (PCI) were enrolled. Repeat revascularization were required in 44 patients, and, unexpectedly, neither low-density lipoprotein cholesterol (LDL-C), HDL-C levels, nor LDL-C/HDL-C ratio were associated with the requirement of PCI (LDL-C, 98.8±24.9 vs. 93.2±21.8mg/dl, p=0.21; HDL-C, 48.2±10.7 vs. 45.0±10.0mg/dl, p=0.11; LDL-C/HDL-C, 2.14±0.71 vs. 2.16±0.66, p=0.85; PCI (+) vs. (-), ± SD, respectively). In contrast, serum MPO levels were higher, and serum PON1 activity were lower in patients who underwent revascularization, significantly (MPO, 381.4±480.6 vs. 195.9±204.3ng/ml, p=0.011; PON1, 216.5±75.9 vs. 249.8±60.7U/L, p=0.025). Thus, MPO/PON1 ratio was significantly higher in patients who underwent PCI (2.61±3.87 vs. 1.03±1.05, p=0.010). After adjustment by age, gender, smoking, hypertension, dyslipidemia and diabetes mellitus, high MPO/PON1 ratio (>1.68, arbitrarily determined by an ROC curve) were independently correlated with repeat revascularization after PCI (odds ratio 7.34, 95% CI 2.0-29.8; p=0.003). In addition, regardless of reasons for revascularization, MPO/PON1 ratio provided similar relationship (in-stent restenosis, 3.02±4.33, n=20; de novo coronary stenosis in non-target lesion, 2.81±4.63, n=24; p values vs. PCI (-) were 0.005 and 0.011, respectively).
Conclusion: MPO/PON1 ratio was associated with revascularization rates after PCI, whereas HDL-C lacks such correlations. This study suggests that MPO/PON1 ratio could be a novel marker and modulator in secondary prevention of CAD.
- © 2010 by American Heart Association, Inc.