Su Tong, Shao Xiaonan, Yang Ling, Zhang Xiaopu, Yang Chengjian
Department of Cardiology, the Third Affiliated Hospital of Soochow University, the First People's Hospital of Changzhou, Changzhou 213003, Jiangsu, China.
Department of Nuclear Medicine, the Third Affiliated Hospital of Soochow University, the First People's Hospital of Changzhou, Changzhou 213003, Jiangsu, China.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2021 May;33(5):568-572. doi: 10.3760/cma.j.cn121430-20200907-00614.
To evaluate the diagnostic value of circulating microRNA-1 (miR-1) in early coronary artery plaque rupture in patients with stable coronary artery disease (SCAD).
A prospective cohort study was conducted. Sixty-seven patients with SCAD admitted to the department of cardiology of the Third Affiliated Hospital of Soochow University from January to June in 2019 were enrolled. All patients had completed coronary angiography (CAG), percutaneous coronary intervention (PCI) single stent implantation or only CAG was performed according to the CAG results. Blood samples were collected before (0 hour) and 3 hours after the procedure. The expression of plasma miR-1 was detected by real-time quantitative reverse transcription-polymerase chain reaction (RT-PCR), and electrocardiogram was used to detect cardiac troponin I (cTnI) levels. The difference of miR-1 and cTnI levels in PCI or CAG patients before and after procedure were compared, and the value for early diagnosis of coronary artery plaque rupture in SCAD patients was evaluated. The diagnostic efficacy was evaluated by the receiver operating characteristic curve (ROC curve).
There were 38 CAG patients and 29 PCI patients. There were no significant differences in gender, age, previous history (without hypertension history) and baseline data of cardiac function between the two groups. The expression of miR-1 after PCI was significantly higher than that before PCI [2: 2.11 (1.56, 2.73) vs. 1.26 (1.07, 1.92), P < 0.01], and there was no significant difference in cTnI level before and after PCI [μg/L: 0.00 (0.00, 0.02) vs. 0.00 (0.00, 0.02), P > 0.05]. There were no significant differences in miR-1 and cTnI levels before and after procedure in the CAG group [miR-1 (2): 1.09 (1.00, 1.40) vs. 1.21 (1.00, 1.71), cTnI (μg/L): 0.00 (0.00, 0.02) vs. 0.00 (0.00, 0.02), both P > 0.05]. ROC curve analysis showed that the area under ROC curve (AUC) and 95% confidence interval (95%CI) of miR-1 in the diagnosis of coronary plaque rupture were 0.794 (0.687-0.900), P < 0.01, the sensitivity was 82.8%, the specificity was 68.4%, and the optimal cut-off value was 1.51. The AUC and 95%CI of the difference of miR-1 before and after operation (ΔmiR-1) were 0.704 (0.567-0.842), P = 0.004, the sensitivity was 62.1%, the specificity was 84.2%, and the optimal cut-off value was 0.39. The efficancy of miR-1 and ΔmiR-1 after procedure to diagnose coronary plaque rupture in patients with SCAD was similar (Z = 1.287, P = 0.198). However, baseline miR-1 might not predict whether patients with SCAD need PCI or not (AUC = 0.630, P > 0.05). Multivariate binary Logistic regression analysis showed that increased postoperative miR-1 expression was an independent risk factor for coronary plaque rupture in SCAD patients [odds ratios (OR) = 2.887, 95%CI was 1.044-7.978, P = 0.041].
Circulating miR-1 might have the value for early diagnosis of coronary artery plaque rupture in SCAD patients.
评估循环微小RNA-1（miR-1）在稳定型冠心病（SCAD）患者早期冠状动脉斑块破裂中的诊断价值。
进行一项前瞻性队列研究。纳入2019年1月至6月在苏州大学附属第三医院心内科住院的67例SCAD患者。所有患者均完成冠状动脉造影（CAG），根据CAG结果行冠状动脉介入治疗（PCI）单支架植入或仅行CAG。分别在术前（0小时）和术后3小时采集血样。采用实时定量逆转录-聚合酶链反应（RT-PCR）检测血浆miR-1的表达，采用心电图检测心肌肌钙蛋白I（cTnI）水平。比较PCI或CAG患者术前、术后miR-1和cTnI水平的差异，评估其对SCAD患者冠状动脉斑块破裂早期诊断的价值。采用受试者工作特征曲线（ROC曲线）评估诊断效能。
CAG组38例，PCI组29例。两组患者在性别、年龄、既往史（无高血压病史）及心功能基线数据方面差异无统计学意义。PCI术后miR-1表达明显高于术前[2：2.11（1.56，2.73）对1.26（1.07，1.92），P<0.01]，PCI术前、术后cTnI水平差异无统计学意义[μg/L：0.00（0.00，0.02）对0.00（0.00，0.02），P>0.05]。CAG组术前、术后miR-1和cTnI水平差异无统计学意义[miR-1（2）：1.09（1.00，1.40）对1.21（1.00，1.71），cTnI（μg/L）：0.00（0.00，0.02）对0.00（0.00，0.02），P均>0.05]。ROC曲线分析显示，miR-1诊断冠状动脉斑块破裂的ROC曲线下面积（AUC）及95%置信区间（95%CI）为0.794（0.687-0.900），P<0.01，敏感度为82.8%，特异度为68.4%，最佳截断值为1.51。术后miR-1差值（ΔmiR-1）的AUC及95%CI为0.704（0.567-0.842），P=0.004，敏感度为62.1%，特异度为84.2%，最佳截断值为0.39。术后miR-1和ΔmiR-1诊断SCAD患者冠状动脉斑块破裂的效能相似（Z=1.287，P=0.198）。然而，基线miR-1可能无法预测SCAD患者是否需要行PCI（AUC=0.630，P>0.05）。多因素二元Logistic回归分析显示，术后miR-1表达升高是SCAD患者冠状动脉斑块破裂的独立危险因素[比值比（OR）=2.887，95%CI为1.044-7.978，P=0.041]。
循环miR-1可能对SCAD患者冠状动脉斑块破裂具有早期诊断价值。
