Serial Measurement of Monocyte Chemoattractant Protein-1 After Acute Coronary SyndromesResults From the A to Z Trial
James A. de Lemos, MD, FACC*,*,
David A. Morrow, MD, MPH, FACC ,
Michael A. Blazing, MD, FACC ,
Petr Jarolim, MD, PhD ,
Stephen D. Wiviott, MD, FACC,
Marc S. Sabatine, MD, MPH, FACC,
Robert M. Califf, MD, MACC and
Eugene Braunwald, MD, MACC
* Donald W. Reynolds Cardiovascular Clinical Research Center, UT Southwestern Medical Center, Dallas, Texas
TIMI Study Group, Brigham and Women’s Hospital, Boston, Massachusetts
Department of Pathology, Brigham and Women’s Hospital, Boston, Massachusetts
Duke Clinical Research Institute, Durham, North Carolina.
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Figure 1 Influence of Early and Intensive Statin Therapy on Median Plasma Levels of MCP-1
Although levels of monocyte chemoattractant protein (MCP)-1 were significantly lower in the simvastatin 40 mg/80 mg arm at 4 months, the difference between the groups was quantitatively modest.
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Figure 2 Baseline MCP-1 Levels and Mortality After ACS
Nelson-Aalen cumulative hazard estimates comparing patients with baseline monocyte chemoattractant protein (MCP)-1 levels >238 versus  238 pg/ml. ACS = acute coronary syndrome.
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Figure 3 Association Between Baseline Levels of MCP-1 and Mortality
Levels are stratified by C-reactive protein (CRP) (A) and brain natriuretic peptide (BNP) (B). High monocyte chemoattractant protein (MCP)-1 levels are defined as >238 pg/ml, high CPR as >15 mg/l, and high BNP as >80 pg/ml.
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Figure 4 MCP-1 Levels at 4 Months After ACS and Subsequent Mortality
Nelson-Aalen cumulative hazard estimates showing the association between monocyte chemoattractant protein (MCP)-1 levels >238 versus 238 pg/ml at 4 months and mortality from 4 months through the end of the study period. Events before 4 months were censored. ACS = acute coronary syndrome.
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Figure 5 Serial Changes in MCP-1 and Subsequent Mortality
Nelson-Aalen cumulative hazard estimates in subgroups defined by monocyte chemoattractant protein (MCP)-1 levels at baseline and at 4 months. High MCP-1 levels are defined as >238 pg/ml and low as 238 pg/ml. Each curve represents a subgroup defined by baseline/4 month MCP-1 levels. Events before 4 months were censored. Patients with MCP-1 levels >238 pg/ml at both baseline and 4 months had significantly higher mortality rates compared with the other groups.
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Figure 6 Incorporation of MCP-1 Into a Multiple Biomarker Panel
Unadjusted association between the number of elevated biomarkers (monocyte chemoattractant protein [MCP]-1, brain natriuretic peptide [BNP], and C-reactive protein [CRP]) at baseline (A) and at 4 months (B) and subsequent mortality. An MCP-1 elevation was defined as >238 pg/ml, and BNP elevation as >80 pg/ml; CRP elevation at baseline was defined as >15 mg/l and at 4 months as >3 mg/l. Multivariable adjustment is shown at the bottom of each panel using variables described in the text. HR = hazard ratio.
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