Department of Cardiology, University Medical Center Utrecht, The Netherlands.
EMBO Mol Med. 2012 Nov;4(11):1176-85. doi: 10.1002/emmm.201201749. Epub 2012 Oct 1.
Previous studies investigating the role of circulating microRNAs in acute coronary syndrome (ACS) were based on small patient numbers, performed no comparison with established markers of cardiac injury and did not have appropriate controls. We determined the potential diagnostic value of circulating microRNAs as novel early biomarkers in 332 suspected ACS patients on presentation to the emergency department (ED) in a prospective single-centre study including cardiac miRNAs (miR-1, -208a and -499), miR-21 and miR-146a. Levels of all miRs studied were significantly increased in 106 patients diagnosed with ACS, even in patients with initially negative high-sensitive (hs) troponin or symptom onset <3 h. MiR-1, miR-499 and miR-21 significantly increased the diagnostic value in all suspected ACS patients when added to hs-troponin T (AUC 0.90). These three miRs were strong predictors of ACS independent of clinical co-variates including patient history and cardiovascular risk factors. Interestingly, the combination of these three miRs resulted in a significantly higher AUC of 0.94 than hs-troponin T (0.89). Circulating microRNAs hold great potential as novel early biomarkers for the management of suspected ACS patients.
先前研究循环 microRNAs 在急性冠状动脉综合征 (ACS) 中的作用基于小数量的患者，没有与心脏损伤的既定标志物进行比较，也没有适当的对照。我们在一项前瞻性单中心研究中，在急诊科就诊的 332 例疑似 ACS 患者中，确定了循环 microRNAs 作为新型早期生物标志物的潜在诊断价值，包括心脏 microRNAs (miR-1、-208a 和 -499)、miR-21 和 miR-146a。在诊断为 ACS 的 106 例患者中，所有研究的 microRNAs 水平均显著升高，即使在最初高敏肌钙蛋白阴性或症状发作 <3 小时的患者中也是如此。当将 microRNA-1、microRNA-499 和 microRNA-21 添加到高敏肌钙蛋白 T 时，它们显著提高了所有疑似 ACS 患者的诊断价值（AUC 0.90）。这三种 microRNAs 是 ACS 的独立预测因子，不受包括病史和心血管危险因素在内的临床协变量的影响。有趣的是，这三种 microRNAs 的组合导致 AUC 显著高于高敏肌钙蛋白 T (0.94 vs. 0.89)。循环 microRNAs 作为疑似 ACS 患者管理的新型早期生物标志物具有巨大潜力。
