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European Heart Journal Advance Access originally published online on January 31, 2005
European Heart Journal 2005 26(5):457-463; doi:10.1093/eurheartj/ehi111
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© The European Society of Cardiology 2005. All rights reserved. For Permissions, please e-mail: journals.permissions{at}oupjournals.org

Elevated serum neopterin predicts future adverse cardiac events in patients with chronic stable angina pectoris

Pablo Avanzas{dagger}, Ramon Arroyo-Espliguero{dagger}, Juan Quiles, Debashis Roy and Juan Carlos Kaski*

Department of Cardiological Sciences, St George's Hospital Medical School, Cranmer Terrace, London SW17 0RE, UK

Received 22 September 2004; revised 2 December 2004; accepted 9 December 2004; online publish-ahead-of-print 31 January 2005.

* Corresponding author. Tel: +44 20 8725 3963; fax: +44 20 8725 3328. E-mail address: jkaski{at}sghms.ac.uk

Aims Serum levels of neopterin, an immune modulator secreted by activated macrophages, are elevated in patients with acute coronary syndromes compared with stable angina patients and control subjects. In unstable angina, serum neopterin levels correlate with the presence of vulnerable coronary stenosis, multiple complex coronary lesions, and patient outcome. The present study assessed the prognostic significance of raised serum neopterin concentrations in patients with stable angina pectoris.

Methods and results We carried out a 1-year follow-up prospective study in 297 patients with chronic stable chest pain undergoing diagnostic coronary angiography. The primary study endpoint was the composite of non-fatal myocardial infarction, unstable angina, and cardiac death. Fifty-one patients (17.2%) had adverse coronary events during follow-up. Mean serum neopterin levels were significantly higher in patients with events compared with those without (P=0.02). On multiple regression analysis, neopterin levels (P=0.021), severity of coronary artery disease (P=0.009), and a history of previous myocardial infarction (P=0.001) were independent predictors of adverse events.

Conclusions Serum neopterin is an independent predictor of major adverse coronary events in patients with chronic stable angina pectoris. This marker of macrophage activation may be useful for risk stratification in patients with chronic stable angina.

Key Words: Neopterin • Cardiac events • Angina pectoris • Inflammation


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