The long pentraxin 3 (PTX3): a novel prognostic inflammatory marker for mortality in acute chest pain

Abstract

The long pentraxin 3 (PTX3) is a recently identified member of the pentraxin protein family that includes C-reactive protein. PTX3 is produced by the major cell types involved in atherosclerotic lesions in response to inflammatory stimuli, and elevated plasma levels are found in several conditions including acute coronary syndromes (ACS). The aim of this study was to assess the value of PTX3 as a prognostic marker of mortality and recurrent ischaemic events in a consecutive series of patients admitted with acute chest pain and potential ACS. The patients received follow-up for 24 months. Blood samples were taken on admission for measurement of PTX3, high sensitive C-reactive protein (hsCRP), B-type natriuretic peptide (BNP), and troponin T. All-cause mortality at 24 months in the study cohort was 15.2%. Patients in the upper PTX3 quartiles had a significantly higher death risk than those in the lowest quartile (Q3: hazard ratio [HR] 2.36; 95% CI 1.12-4.99; p = 0.024, and Q4: HR 3.60; 95% CI 1.68-7.72; p = 0.001). Elevated BNP levels were also significantly associated with a fatal outcome (Q3: HR 3.05; 95% CI 1.16-7.99; p = 0.024; and Q4: HR 3.90; 95% CI 1.48-10.26; p = 0.006). Elevation in hsCRP was not associated with increased death risk. As PTX3 predicted mortality independently of BNP, the combination of these two biomarkers showed an incremental prognostic value. PTX3 is a new biomarker related to inflammation that, independently of BNP, strongly predicts long-term all-cause mortality in patients with acute chest pain. The combination of these two biomarkers enhances the prognostic value over either marker alone.

Pentraxin‐3 level at admission is a strong predictor of short‐term mortality in a community‐based hospital setting

“…The results of previous studies have suggested that some biomarkers, including PTX3, perform better when used in combination rather than individually. This is true for PTX3 combined with pro-BNP [26,35] or troponin T [33,36,42] in patients with heart disease. Similarly, a combinatorial approach for diagnosing sepsis with a 'bioscore' comprising three markers, neutrophil CD64 index, procalcitonin (PCT; a marker of infection) and a soluble triggering receptor on myeloid cells-1 (sTREM-1), has been shown to be clinically useful [43].…”

Pentraxins in innate immunity: lessons from PTX3

“…Patients with arterial inflammation, who are eligible for coronary intervention, exhibit high concentrations of plasma PTX3; in particular, patients with unstable angina pectoris have PTX3 levels three times higher than the normal range (Inoue et al 2007). Thus, PTX3 is a new candidate for being a prognostic marker in ischaemic heart disorders including AMI (Brugger-Andersen et al 2009;Jenny et al 2009;Latini et al 2004;Matsui et al 2010). Likewise, PTX3 has been suggested as a useful inflammatory biomarker for predicting cognitive impairment in elderly hypertensive patients (Yano et al 2010).…”

Long-term prognostic utility of pentraxin 3 and D-dimer as compared to high-sensitivity C-reactive protein and B-type natriuretic peptide in suspected acute coronary syndrome

“…We have previously demonstrated that PTX3 may serve as a prognostic indicator at 24 months of follow-up. 10 D-dimer is a fibrinolytic split product of plasmindegraded cross-linked fibrin. 11 It has been shown to be increased in conditions such as unstable CAD, 12 and some authors regard the development of an ACS as a failure of timely spontaneous fibrinolysis.…”