A Biomarker Model to Distinguish Types of Myocardial Infarction and Injury

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:78

Article

Neumann, T. Johannes^1,2,3  Weimann, Jessica¹  Sorensen, Nils A.^1,2  Hartikainen, S. Tau¹  Haller, M. Paul^1,2  Lehmacher, Jonas¹  Brocks, Celine¹  Tenhaeff, Sophia¹  Karakas, Mahir^1,2  Renne, Thomas⁴  Blankenberg, Stefan^1,2  Zeller, Tanja^1,2  Westermann, Dirk^1,2 

[1] Univ Heart & Vasc Ctr, Dept Cardiol, Martinistr 52, D-20246 Hamburg, Germany

[2] German Ctr Cardiovasc Res, Partner Site Hamburg Kiel Lubeck, Hamburg, Germany

[3] Monash Univ, Sch Publ Hlth & Prevent Med, Dept Epidemiol & Prevent Med, Melbourne, Australia

[4] Univ Med Ctr Hamburg Eppendorf, Inst Clin Chem & Lab Med, Hamburg, Germany

关键词: biomarker;    copeptin;    myocardial infarction;    myocardial injury;    NT-proBNP;    troponin;    type 1;    type 2;    acute coronary syndrome;   

DOI  :  10.1016/j.jacc.2021.06.027

来源: Elsevier

【 摘 要 】

BACKGROUND Discrimination among patients with type 1 myocardial infarction (T1MI), type 2 myocardial infarction (T2MI), and myocardial injury is difficult. OBJECTIVES The aim of this study was to investigate the discriminative value of a 29-biomarker panel in an emergency department setting. METHODS Patients presenting with suspected myocardial infarction (MI) were recruited. The final diagnosis in all pa-tients was adjudicated on the basis of the fourth universal definition of MI. A panel of 29 biomarkers was measured, and multivariable logistic regression analysis was used to evaluate the associations of these biomarkers with the diagnosis of MI or myocardial injury. Biomarkers were chosen using backward selection. The model was internally validated using bootstrapping. RESULTS Overall, 748 patients were recruited (median age 64 years), of whom 138 had MI (107 T1MI and 31 T2MI) and 221 had myocardial injury. In the multivariable model, 4 biomarkers (apolipoprotein A-II, N-terminal prohormone of brain natriuretic peptide, copeptin, and high-sensitivity cardiac troponin I) remained significant discriminators between T1MI and T2MI. Internal validation of the model showed an area under the curve of 0.82. For discrimination between MI and myocardial injury, 6 biomarkers (adiponectin, N-terminal prohormone of brain natriuretic peptide, pulmonary and activation-regulated chemokine, transthyretin, copeptin, and high-sensitivity troponin I) were selected. Internal valida-tion showed an area under the curve of 0.84. CONCLUSIONS Among 29 biomarkers, 7 were identified to be the most relevant discriminators between subtypes of MI or myocardial injury. Regression models based on these biomarkers allowed good discrimination. (Biomarkers in Acute Cardiac Care [BACC]; NCT02355457) (J Am Coll Cardiol 2021;78:781-790) (c) 2021 by the American College of Cardiology Foundation.

【 授权许可】

Free