A Synergistic Role of Myeloperoxidase and High Sensitivity Troponin T in the Early Diagnosis of Acute Coronary Syndrome

Abstract

Aim of this study was to evaluate the role of Myeloperoxidase (MPO) and high sensitive Troponin T in the early diagnosis of acute coronary syndrome (ACS). This was a cross sectional study that comprised of 120 individuals of which 75 were cases and 45 healthy controls. On the basis of clinical history and 12 lead electrocardiogram initial diagnosis of ACS was made in the cases. MPO and high sensitive Troponin T (hs-cTnT) was measured in all the individuals. Levels of MPO were significantly higher in patients of ACS as compared to those in control group [medians: 15.40 (95% CI 11.06-20.84) vs 5.84 (95% CI 5.50-6.44)]. By taking the cut off as >11.87U/mL for MPO, its sensitivity was 87% (95% CI 73.7-95.1), specificity was 97.3% (95% CI 90.6-99.7), positive predictive value was 94.6% and negative predictive value was 92.6%. Positive likelihood ratio was 33.0 while negative likelihood ratio was 0.13, whereas the corresponding values in case of hs-cTnT were 95.6% (95% CI 85.2-99.5), 61.3% (95% CI 49.5-72.6), 59.7%, 95.8%, 2.47 and 0.07 by taking cut off as >14pg/ml. The area under the ROC curves (AUC) of MPO and hscTnT at 0-6h were 0.971 (95% CI 0.92-0.99, P<0.001) and 0.797 (95% CI 0.71-0.86, P<0.001) respectively. The logistic model combining the two markers yielded sensitivity, specificity, positive predictive value and negative predictive value of 95.7, 97.3, 98.2 and 93.7% respectively. It was concluded that MPO and hs-cTnT may be useful tools for risk stratification of ACS and can be used together with better accuracy in the early diagnosis of ACS.