Circulating NETosis markers in NSTEMI and predicting of 1-year cardiac death

Abstract Aim Evaluation of serum levels of markers having reliable link to NETosis phenomenon in patients with NSTEMI as well as their predictive value on 1-year cardiac death. Material and methods The study was undergone in 123 patients with NSTEMI without diabetes mellitus exposed to angioplasty. The admission serum level of 7 markers having specific (myeloperoxidase (MPO), metalloproteinase 8 (MMP8), neutrophil elastase (NE)) or less specific (selectin E (SE), ICAM-1, IL-8 and phospholipase A2 (PhA2)) pathogenic relation to NETosis have been determined using ELISA technic. Control markers have been assayed in 40 healthy persons. Post-infarction cardiac death rate was appreciated during 12 moths, and the inherent prediction value of these markers has been estimated using hazard ratio CI (95%). Results The revealed highest incremental variation of markers from control was characteristic for specific markers of NETosis: MYO by 156% (77,6±13,8 vs 30,4±5,5 U/ml), NE by 114% (35,9±6,2 vs 16,8±3,6 ng/ml) and MMP8 by 83% (53,8±9,4 vs 29,5±5,4 ng/ml). The other markers increased significantly, but in a lower range, 49-71%. The 1-year mortality rate reached a level of 18% (22 patients). The predictive value of studied markers according to risk of cardiac death for 1 year was also highest among direct markers of NETosis: MYO, HR 3,16 CI (1,98-5,25, p<0,01), NE, HR 2,73 CI (1,44-4,16, p<0,01) and MMP8 HR 2,38 CI (1,13-3,89, p<0,01). Conclusion A markedly increased admission serum level of MYO, NE and MMP8 (83-156%) in patients with NSTEMI justifies the pathogenetic role of NETosis as well as the diagnostical importance of these markers. Likewise, these markers quite highly predict 1-year cardiac death, and therefore could be useful in post-infarction prognosis.