Correlation between plasma myeloperoxidase and hs-troponin I, C-reactive protein and CKMB in acute coronary syndrome


  • Anusha A. M. Department of Pathology, PK Das Institute of Medical Sciences, Palakkad, Kerala, India
  • Sinju Rajan Department of Biochemistry, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India
  • Annamala P. T. Department of Biochemistry, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India
  • Govindanunni T. Department of Cardiology, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India



Acute coronary syndrome, High sensitivity troponin I, Myeloperoxidase


Background: Acute coronary syndrome (ACS) is a group of clinical syndromes ranging from unstable angina pectoris to acute myocardial infarction (AMI) and death. Early prediction of ACS is frequently a challenging task. Myeloperoxidase is involved in oxidative stress and inflammation which plays an important role in the pathogenesis and course of ACS.

Methods: The study was conducted in 30 male patients in the age group 20 - 80 years who were diagnosed as ACS and admitted to CCU. Twenty age matched normal subjects were taken as controls. Plasma MPO, hsTnI, hsCRP, CKMB, lipid parameters, urea, creatinine, glucose, AST and LDH were estimated in  patients and control subjects.

Results: Plasma MPO level was found to be 155.5±19.5 ng/ml and 62.4±11.8 in ACS patients and normal controls respectively and that of hsTnI was 133.3±10.1 ng/L  and 20.7±1.8 ng/L, hsCRP to be 13.1±1.38 mg/L and 0.51±0.12 mg/L, CKMB to be 166.3±16.7  ng/dl and 12.8±1.51 ng/dl respectively. The values plasma of glucose, cholesterol, triglycerides, HDL-cholesterol, LDL-cholesterol, urea and creatinine were found to be slightly elevated in patients but, were not statistically significant when compared to controls. AST and LDH showed statistically significant increase in patients compared to controls. Direct linear correlation was observed between plasma MPO level and hsTnI, hsCRP and CKMB levels.

Conclusions: Plasma MPO which is a predictor of early cardiovascular events and also severity of myocardial damage linearly correlates with the values of hsTnI, hsCRP and CKMB.


Kumar A, Cannon CP. Acute coronary syndromes: Diagnosis and management, Part I. Mayo Clin Proc. 2009;84:917-38.

Dasgupta A, Wahed A. Cardiac Markers. In: Clinical Chemistry, Immunology and Laboratory Quality Control. Elsevier; 2014:127-144.

Goldman BU, Rudolph V, Rudolph TK, Holle AK, Hillebrandt M, Meinertz T, et al. Neutrophil activation precedes myocardial injury in patients with acute myocardial infarction. Free Radic Biol Med. 2009;47:79-83.

Zhang R, Brennan ML, Fu X, Aviles RJ, Pearce GL, Penn MS, et al. Association between myeloperoxidase levels and risk of coronary artery disease. JAMA. 2001;286:2136-42.

Nderepepa G, Braun S, Mehille J, van Beckerath N, Schomig A, Kasrati A. Myeloperoxidase level in patients with stable coronary artery disease and acute coronary syndromes. Eur J Clin Invest. 2008; 38:90-6.

Duzguncinar O, Yavuz B, Hazirola T, Deniz A, Tokgozoglu SL, Akata D, et al. Plasma myeloperoxidase is related to the severity of coronary artery disease. Acta Cardiol. 2008;63: 147-52.

Fong SW, Few LL, Too WCS, Khoo By, Ibrahim NNIN, Yahaya SA, et al. Systemic and coronary levels of CRP, MPO,sCD40L and PIGF in patients with coronary artey disease. BMC Res Noted. 2015;8:679-88.

Nderepepa G. Myeloperoxidase – A bridge linking inflammation and oxidative stress with cardiovascular disease. Clinica Chimica Acta. 2019;493:36-51.

Sheik N, Patel DC. A review of troponins in ischemic heart disease and other conditions. Int J Angiol. 2007;16:53-8.

Antman E M. Decision making with cardiac troponin tests. N New Engl J Med. 2002;346:2079-82

Luepker RV, Apple FS, Christenson RH, Crow RS, Fortman SP, Goff D, et al. Case definitions for acute coronary heart disease in epidemiology and clinical research studies: a statement from AHA council on Epidemiology and Prevention, AHA Statistics Committee, World Heart Federation Council on Epidemiology and Prevention, the European Society for Cardiology working group on epidemiology and Prevention and the National Heart, Lung and Blood Institute. Circulation. 2003;108:2543-9.

Kozinski M, Krintus M, Kubica J, Sypniewska D. High sensitive troponin assays: From improved analytical performance to enhanced risk stratification. Crit Rev Clin Lab Sci. 2017;54:143-72.

Byun J, Mueller GM, Fabjan JS and Heinecke JW. Nitrogen peroxide radical generated by myeloperoxidase – hydrogen peroxide – nitrite system promotes lipid peroxidation of low density lipoproteins. FEBS Lett. 1999;455:243-6.

De Servi S, Mazonne A, Ricevuti G, Mazzucchelli I, Fossati G, Angoli L, et al. Expression of neutrophil and monocyte CD11B/CD18 adhesion molecules at different sites of coronary tree in unstable angina Pectoris. Am J Cardiol. 1996;78:564-8.

Sugiyama S, Kugiyama K, Aikava M, Nakamura S, Ogawa H, Libby P. Hypochlorous acid, a macrophage product, induces endothelial apoptosis and tissue factor expression involvement of myeloperoxidase- mediated oxidant in plaque erosion and thrombogenesis. Atherosclerosis, Thromb Vascular Biol. 2004;24:1309-14.

Shiu SW, Xiao SM, Wong Y, Chow WS, Lam KS, Tan KC. Carbamylation of LDL and its relationship with myeloperoxidase in type 2 diabetes mellitus. Clinical Sci. 2014;126:178-81.

Meuwese MC, Stroes ES, Hazen SL, van Meirt JN, Kuivenhoven, Schaub Rg, et al. Serum MPO levels are associated with the future risk of coronary artery disease in apparently healthy individuals The EPIC-Norfolk Prospective population study. J Am Coll Cardiol. 2007;50:159-65.

Mocatta TJ, Pilbrow AP, Cameron VA, Senthilmohan R, Frampton CM, Richardson AM, et al. Plasma concentration of myeloperoxidase predict mortality in myocardial infarction. J Am Coll Cardiol. 2007;49:1993-2000.

Heslop CL, Frohlich J, Hill JS. Myeloperoxidase and C-reactive protein have combined utility for long term prediction of cardiovascular mortality after coronary angiography. J Am Coll Cardiol. 2010;55:1102-9.

Tang W, Wu Y, Nicholls SJ, Hazen SL. Plasma peroxidase predicts incident cardiovascular risks in stable patients undergoing medical management for coronary artery disease. Clin Chem. 2011;57:33-9.

Tubaro M, Vranckz P, Price S, Vrints C (Eds). The ESC Text Book of Intensive and Acute Cardiovascular diseases. 2nd Edition. Oxford University Press; 2015:316-320.

Joshua RL, Wai HL, Germaine W, Samnel A, Kun Z , Ee ML, et al. Association between high sensitive troponin I and cardiac events in Elderly women. J Am Heart Assoc. 2017;6:ee004174.

Apple FS, Ler R, Murakami M. Determination of cardiac troponin I and T assay 99th percentile values from a common presumably healthy population. Clin Chem. 2012;58:1574-81.

Eggers KM, Venge P, Lindhal B, Lind L. Cardiac troponin I levels measured with high sensitive assay increase over time and are strong predictors of mortality in an elderly population. J Am Coll Cardiol. 2013;61:1906-13.

Niskanen M, Saramaki M, Schwandt E. Myeloperoxidase and hs-CRP as predictive factors for myocardial infarction. Clin Lab Invest. 2006; 30:38-9.






Original Research Articles