Abstract
Inflammation plays a pivotal role in the etiology of coronary artery disease (CAD). Myeloperoxidase (MPO) is a potent inflammatory factor and a critical modulator of coronary inflammation and oxidative stress. The goal of this study was to determine the impact of the plasma MPO (pMPO) level and neutrophil/lymphocyte ratio on the clinical characteristics and outcomes of patients with CAD. Blood samples were collected from 210 patients with underlying chest pain or recent myocardial infarction (MI) prior to coronary angiography in order to measure pMPO levels. The pMPO levels and neutrophil/lymphocyte ratio were correlated with clinical characteristics and outcomes following catheterization. The pMPO level and neutrophil/lymphocyte ratio were higher in patients with recent MI than in patients with CAD (coronary occlusion ≥50%) or without CAD (coronary occlusion <50%). Patients with ST segment elevated MI (STEMI) had a higher neutrophil/lymphocyte ratio relative to patients with non-STEMI. The pMPO level was identified to correlate with the neutrophil/lymphocyte ratio and the need for coronary artery reperfusion by coronary artery bypass surgery or percutaneous coronary intervention. Patients who were taking aspirin had lower pMPO levels and neutrophil/lymphocyte ratio compared with those who were not taking aspirin. The plasma neutrophil/lymphocyte ratio was negatively associated with the left ventricular ejection fraction at baseline and the 30-day follow-up, whereas pMPO showed no correlation. Multivariate analysis indicated that the pMPO level was positively associated with MI, the neutrophil/lymphocyte ratio and coronary intervention. The preoperative use of aspirin was associated with a lower pMPO level and neutrophil/lymphocyte ratio. In conclusion, pMPO is positively associated with MI, the neutrophil/lymphocyte ratio and coronary intervention. The preoperative use of aspirin is associated with a lower pMPO level and neutrophil/lymphocyte ratio. pMPO may serve as a predictor of coronary intervention and as a potential therapeutic target for the reduction of inflammation in patients with CAD.
Highlights
The principal mechanisms underlying the development of coronary artery atherosclerosis and myocardial infarction (MI) are numerous and complex
It was found that plasma MPO (pMPO) levels were elevated in the patients with recent MI compared with those in patients with or without Coronary artery disease (CAD) and correlate with the neutrophil/lymphocyte ratio, suggesting that the increased circulatory neutrophils promote MPO release, plaque formation and the development of MI
Neutrophil infiltration is actively associated with plaque rupture and MI [3]
Summary
The principal mechanisms underlying the development of coronary artery atherosclerosis and myocardial infarction (MI) are numerous and complex. Coronary artery disease (CAD) is associated with significant patient morbidity and mortality. A larger infarction size and greater mortality are associated with ST‐segment elevation myocardial infarction (STEMI) compared with non‐STEMI [1]. Inflammation is increasingly being considered as a key player and critical feature in coronary atherosclerosis [2]. Previous studies have observed that areas of plaque rupture are associated with increased levels of inflammatory cells [3,4]. Coronary plaques have been observed to be infiltrated by diffused inflammatory cells, including neutrophils, in patients who succumbed following MI [3,5]. The neutrophil/lymphocyte ratio is known to be an important predictor of adverse outcomes in MI [6]
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