Zentrum für Innere Medizin, Klinik für Kardiologie, Angiologie und Pneumologie, Universitätsklinikum Heidelberg, Germany.
Institute of Molecular and Translational Therapeutic Strategies (IMTTS), Hannover Medical School, Hannover, Germany.
Eur Heart J Acute Cardiovasc Care. 2021 Aug 24;10(6):653-660. doi: 10.1093/ehjacc/zuaa034.
To assess the diagnostic value of microRNAs (miRNAs) for the detection of non-ST-segment elevation myocardial infarction (NSTEMI).
A total of 1042 patients presenting between August 2014 and April 2017 to the emergency department with the suspected acute coronary syndrome were included. Non-ST-segment elevation myocardial infarction was diagnosed per criteria of the fourth Universal definition of myocardial infarction (UDMI) using high-sensitivity troponin T (hs-cTnT). Expression levels of eleven microRNAs (miR-21, miR-22, miR-29a, miR-92a, miR-122, miR-126, miR-132, miR-133, miR-134, miR-191, and miR-423) were determined using RT-qPCR. Discrimination of NSTEMI was assessed for individual and a panel of miRNAs compared to the hs-cTnT reference using C-statistics and reclassification analysis. NSTEMI was diagnosed in 137 (13.1%) patients. The area under the curve (AUC) of the hs-cTnT based reference was 0.937. In a multivariate model, three miRNAs (miR-122, miR-133, and miR-134) were found to be associated with NSTEMI with AUCs between 0.506 and 0.656. A panel consisting of these miRNAs revealed an AUC of 0.662 for the diagnosis of NSTEMI. The AUC of the combination of the miRNA panel and troponin reference was significantly lower than the reference standard (AUC: 0.897 vs. 0.937, P = 0.006). Despite a significant improvement of NSTEMI reclassification measured by IDI and NRI, miRNAs did not improve the specificity of hs-cTnT kinetic changes for the diagnosis of NSTEMI (ΔAUC: 0.04).
Although single miRNAs are significantly associated with the diagnosis of NSTEMI a miRNA panel does not add diagnostic accuracy to the hs-cTnT reference considering baseline values and kinetic changes as recommended by the fourth version of UDMI.
NCT02116153.
评估 microRNAs (miRNAs) 用于检测非 ST 段抬高型心肌梗死 (NSTEMI) 的诊断价值。
共纳入 2014 年 8 月至 2017 年 4 月期间因疑似急性冠状动脉综合征而到急诊科就诊的 1042 例患者。根据第四版心肌梗死通用定义 (UDMI) 中高敏肌钙蛋白 T (hs-cTnT) 的标准诊断非 ST 段抬高型心肌梗死。采用 RT-qPCR 测定 11 种 microRNAs (miR-21、miR-22、miR-29a、miR-92a、miR-122、miR-126、miR-132、miR-133、miR-134、miR-191 和 miR-423) 的表达水平。使用 C 统计量和重新分类分析，比较 hs-cTnT 参考值与个体和 miRNA 组合对 NSTEMI 的鉴别能力。诊断为 137 (13.1%) 例 NSTEMI。hs-cTnT 参考值的曲线下面积 (AUC) 为 0.937。在多变量模型中，发现三种 miRNAs (miR-122、miR-133 和 miR-134) 与 NSTEMI 相关，AUC 在 0.506 至 0.656 之间。由这些 miRNAs 组成的 miRNA 面板诊断 NSTEMI 的 AUC 为 0.662。miRNA 面板与肌钙蛋白参考值组合的 AUC 显著低于参考标准 (AUC：0.897 vs. 0.937，P = 0.006)。尽管通过 IDI 和 NRI 测量的 NSTEMI 重新分类显著改善，但 miRNA 并没有提高 hs-cTnT 动力学变化对 NSTEMI 诊断的特异性 (AUC：0.04)。
尽管单个 miRNAs 与 NSTEMI 的诊断显著相关，但 miRNA 面板与 hs-cTnT 参考值相比，考虑到第四版 UDMI 推荐的基线值和动力学变化，并未增加诊断准确性。
NCT02116153。
