BACKGROUND: Myeloperoxidase (MPO) is proposed for risk stratification in patients with suspected acute coronary syndromes (ACSs). We determined if MPO has diagnostic value in patients being evaluated for ACS. METHOD: MIDAS was an 18-center prospective study enrolling suspected ACS emergency department patients who presented <8 hours after symptom onset and in whom serial cardiac markers and objective cardiac perfusion testing were planned. Blinded MPO (Biosite, Inc, San Diego, CA) and troponin I (Triage Cardio 3; Biosite, Inc) were drawn at arrival, and Troponin I (TnI) was measured at 90, 180, and 360 minutes. Final diagnoses were adjudicated by the local investigator blinded to study assay. RESULTS: Of 1,018 patients, 54% were male, 26% black, with a mean age of 58 ± 13 years. Diagnoses were ACS in 288 (23%) and noncardiac chest pain (NCCP) in 788 (77%). Of patients with ACS, 94 (9.2%) had a myocardial infarction (MI) at presentation (69 non-ST-elevation MI, 25 ST-elevation MI), and 136 had unstable angina. Using a cutpoint of 210 ng/mL to provide 90% specificity, MPO had a sensitivity of 0.18; negative predictive value, 0.69; positive predictive value, 0.47; negative likelihood ratio, 0.91; and a positive likelihood ratio of 1.83 to differentiate ACS and NCCP. Because of the large overlap of quartiles, MPO was not clinically useful to predict serial TnI changes. The C statistics ± 95% CI for MPO differentiating ACS from NCCP and for AMI versus NCCP were 0.629 ± 0.04 and 0.666 ± 0.06, respectively. CONCLUSIONS: Myeloperoxidase has insufficient accuracy for decision making in patients with suspected ACS.
BACKGROUND:Myeloperoxidase (MPO) is proposed for risk stratification in patients with suspected acute coronary syndromes (ACSs). We determined if MPO has diagnostic value in patients being evaluated for ACS. METHOD: MIDAS was an 18-center prospective study enrolling suspected ACS emergency department patients who presented <8 hours after symptom onset and in whom serial cardiac markers and objective cardiac perfusion testing were planned. Blinded MPO (Biosite, Inc, San Diego, CA) and troponin I (Triage Cardio 3; Biosite, Inc) were drawn at arrival, and Troponin I (TnI) was measured at 90, 180, and 360 minutes. Final diagnoses were adjudicated by the local investigator blinded to study assay. RESULTS: Of 1,018 patients, 54% were male, 26% black, with a mean age of 58 ± 13 years. Diagnoses were ACS in 288 (23%) and noncardiac chest pain (NCCP) in 788 (77%). Of patients with ACS, 94 (9.2%) had a myocardial infarction (MI) at presentation (69 non-ST-elevation MI, 25 ST-elevation MI), and 136 had unstable angina. Using a cutpoint of 210 ng/mL to provide 90% specificity, MPO had a sensitivity of 0.18; negative predictive value, 0.69; positive predictive value, 0.47; negative likelihood ratio, 0.91; and a positive likelihood ratio of 1.83 to differentiate ACS and NCCP. Because of the large overlap of quartiles, MPO was not clinically useful to predict serial TnI changes. The C statistics ± 95% CI for MPO differentiating ACS from NCCP and for AMI versus NCCP were 0.629 ± 0.04 and 0.666 ± 0.06, respectively. CONCLUSIONS:Myeloperoxidase has insufficient accuracy for decision making in patients with suspected ACS.
Authors: Simon A Mahler; Chadwick D Miller; Judd E Hollander; John T Nagurney; Robert Birkhahn; Adam J Singer; Nathan I Shapiro; Ted Glynn; Richard Nowak; Basmah Safdar; Mary Peberdy; Francis L Counselman; Abhinav Chandra; Joshua Kosowsky; James Neuenschwander; Jon W Schrock; Stephen Plantholt; Deborah B Diercks; W Frank Peacock Journal: Int J Cardiol Date: 2012-10-30 Impact factor: 4.164
Authors: Deborah B Diercks; Bryn E Mumma; W Frank Peacock; Judd E Hollander; Basmah Safdar; Simon A Mahler; Chadwick D Miller; Francis L Counselman; Robert Birkhahn; Jon Schrock; Adam J Singer; John T Nagurney Journal: Acad Emerg Med Date: 2013-03 Impact factor: 3.451
Authors: W Frank Peacock; Deborah Diercks; Robert Birkhahn; Adam J Singer; Judd E Hollander; Richard Nowak; Basmah Safdar; Chadwick D Miller; Mary Peberdy; Francis Counselman; Abhinav Chandra; Joshua Kosowsky; James Neuenschwander; Jon Schrock; Elizabeth Lee-Lewandrowski; William Arnold; John Nagurney Journal: Ann Lab Med Date: 2016-09 Impact factor: 3.464
Authors: Simon A Mahler; Gregory L Burke; Pamela W Duncan; Larry D Case; David M Herrington; Robert F Riley; Brian J Wells; Brian C Hiestand; Chadwick D Miller Journal: JMIR Res Protoc Date: 2016-01-22