Matrix metalloproteinase-9 is a marker of heart failure after acute myocardial infarction

Background: Matrix metalloproteinases (MMPs) have been associated with the development of left ventricular remodeling after myocardial infarction (MI). We sought to determine whether peripheral levels of MMPs can be used as a risk marker for the development of congestive heart failure (CHF) after acute MI. Methods and Results: Plasma levels of MMP-2, MMP-9, C-reactive protein (hs-CRP), tumor necrosis factor-alpha (TNF-alpha), and pro-brain natriuretic peptide (pro-BNP) were measured in 109 consecutive patients with acute MI treated with primary mechanical reperfusion. Echocardiographic assessment of left ventricular wall motion index was performed during admission. Patients were followed for the development of CHF. Left ventricular function and volumes were determined after 2 years with radionuclide ventriculography. During 2-year follow-up, 15 patients developed congestive heart failure (CHF). Using multivariate analysis, MMP-9 levels were the only circulating factor predictive of late onset CHF. Patients who had high MMP-9 levels had a significant risk of late onset CHF (OR of 6.5, P <=.006) and left ventricular remodeling (Delta EF = -9%, P =.03, and Delta end-diastolic volume = + 13 mL, P =.03). MMP-2, TNF-alpha, hs-CRP, creatine kinase, and pro-BNP were not predictive of late onset CHF. Conclusion: MMP-9 levels may hold prognostic significance in MI patients.