Editorial comment
Metalloproteinases as a prognostic marker in ST-elevation myocardial infarction
Metaloproteinases como marcador prognóstico de STEMI
Jorge Mimoso
Serviço de Cardiologia, Centro Hospitalar e Universitário do Algarve, Faro, Portugal
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Due to interactions between the various risk factors, scores have been created in order to identify populations at greater risk.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In addition to clinical markers, biochemical markers such as elevated troponin T and C-reactive protein levels are strongly related to the long-term risk of death from cardiac causes.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Matrix metalloproteinases (MMPs) are enzymes involved in extracellular matrix remodeling and leukocyte recruitment to sites of inflammation, and act as important inflammatory modulators. MMP-9 plays a key role in the progression of atherosclerosis and vulnerability to plaque rupture,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a> and its plasma levels increase in patients with acute myocardial infarction. However, available data on the specific impact of baseline plasma MMP-9 levels and their utility as a prognostic marker in coronary artery disease are limited and at times conflicting.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">5,6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In this issue of the <span class="elsevierStyleItalic">Journal</span>, Somuncu et al.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a> present a study aiming to assess the clinical significance of MMP-9 in predicting two-year adverse cardiovascular events in patients who underwent primary percutaneous coronary intervention (PCI) after ST-elevation myocardial infarction (STEMI).</p><p id="par0025" class="elsevierStylePara elsevierViewall">In this single-center prospective study, blood was collected from 204 patients with STEMI at hospital admission and before undergoing PCI. Participants were classified as high MMP-9 (n=102) or low MMP-9 (n=102) based on an MMP-9 cut-off of 12.92 ng/ml. Both groups were assessed at one and two years after STEMI.</p><p id="par0030" class="elsevierStylePara elsevierViewall">There was no difference between the high and low MMP-9 groups in terms of baseline or PCI characteristics, but the high MMP-9 group had a significantly higher incidence of cardiopulmonary resuscitation, use of inotropes, cardiogenic shock, intra-aortic balloon pump (IABP) use and no-reflow phenomenon. In-hospital cardiovascular mortality was higher in the high MMP-9 group, but without reaching statistical significance.</p><p id="par0035" class="elsevierStylePara elsevierViewall">When long-term outcomes were analyzed, cardiovascular mortality was significantly higher in the high MMP-9 group at one year (13.7% vs. 4.8% for the low MMP-9 group, p=0.030) and at two years (17.6% vs. 4.9%, p=0.004).</p><p id="par0040" class="elsevierStylePara elsevierViewall">Advanced heart failure was compared between the groups and was significantly more frequent in the high MMP-9 group at two-year follow-up (16.7% vs. 5.9%, p=0.015).</p><p id="par0045" class="elsevierStylePara elsevierViewall">High MMP-9 level was one of the independent predictors of two-year cardiovascular mortality (odds ratio: 3.5; 95% confidence interval: 1.12-11.35), together with age, no-reflow and left ventricular ejection fraction.</p><p id="par0050" class="elsevierStylePara elsevierViewall">An interesting aspect of this study is that the no-reflow phenomenon during the procedure was significantly more frequent in the high MMP-9 group, since no-reflow may lead to cardiogenic shock, inotrope use or the need for IABP, development of advanced heart failure and ultimately cardiovascular mortality.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The authors recognize some limitations of their study. It was a single-center analysis of a relatively small number of patients, and the predictive value of MMP-9 was investigated using 12.92 ng/ml as a cut-off for their cohort, a different value from previous studies, and one that needs validation in other large populations.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Another issue is that all their patients were given clopidogrel rather than ticagrelor or prasugrel, so the precise effect of MMP-9 in MI patients who use newer antiplatelets cannot be determined.</p><p id="par0065" class="elsevierStylePara elsevierViewall">In summary, high MMP-9 levels were an important predictor of major adverse cardiovascular events, including mortality and advanced heart failure, in two-year follow-up in STEMI patients undergoing primary PCI. MMP-9 measurement should therefore be considered as a prognostic marker for STEMI patients.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0070" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0040" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "TIMI risk score for ST-elevation myocardial infarction: a convenient, bedside, clinical score for risk assessment at presentation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "D.A. 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| 2022 Julho | 22 | 39 | 61 |
| 2022 Junho | 28 | 30 | 58 |
| 2022 Maio | 17 | 40 | 57 |
| 2022 Abril | 23 | 36 | 59 |
| 2022 Maro | 40 | 54 | 94 |
| 2022 Fevereiro | 30 | 32 | 62 |
| 2022 Janeiro | 21 | 29 | 50 |
| 2021 Dezembro | 17 | 32 | 49 |
| 2021 Novembro | 23 | 34 | 57 |
| 2021 Outubro | 34 | 54 | 88 |
| 2021 Setembro | 21 | 32 | 53 |
| 2021 Agosto | 30 | 35 | 65 |
| 2021 Julho | 23 | 30 | 53 |
| 2021 Junho | 37 | 22 | 59 |
| 2021 Maio | 34 | 46 | 80 |
| 2021 Abril | 24 | 36 | 60 |
| 2021 Maro | 33 | 28 | 61 |
| 2021 Fevereiro | 21 | 15 | 36 |
| 2021 Janeiro | 28 | 27 | 55 |
| 2020 Dezembro | 25 | 28 | 53 |
| 2020 Novembro | 17 | 26 | 43 |
| 2020 Outubro | 15 | 20 | 35 |
| 2020 Setembro | 31 | 20 | 51 |
| 2020 Agosto | 17 | 23 | 40 |
| 2020 Julho | 85 | 54 | 139 |
| 2020 Junho | 53 | 32 | 85 |
Mostrar tudo
