Mele Marco, Mautone Francesco, Ragnatela Ilaria, D'Alessandro Damiano, Rossi Luciano Umberto, Granatiero Michele, Palmieri Gianpaolo, Giannetti Laura, Diomede Davide, Mele Antonietta, Liantonio Antonella, Imbrici Paola, Correale Michele, Santoro Francesco, Corbo Maria Delia, Vitale Enrica, Magnesa Michele, Brunetti Natale Daniele
Cardiothoracic Department, Policlinico Riuniti Foggia, Foggia Italy.
University of Foggia, Department of Medical and Surgical Sciences, Foggia, Italy.
Heart Lung. 2025 Mar-Apr;70:230-235. doi: 10.1016/j.hrtlng.2024.12.008. Epub 2025 Jan 2.
It is crucial to distinguish type-1 myocardial infarction (T1MI) from type-2 myocardial infarction (T2MI) at admission and during hospitalization to avoid unnecessary invasive exams and inappropriate admissions to the acute cardiac care unit.
The purpose of the study was to define a simple profile derived from commonly used biomarkers to differentiate T1MI from T2MI.
We prospectively enrolled in an observational study 213 iconsecutive patients with a provisional diagnosis of non-ST-elevation acute myocardial infarction (NSTEMI) admitted to the Cardiology Department. A final diagnosis of T1MI, T2MI, and non-ischemic acute myocardial injury (NAMI) was given based on clinical and instrumental findings. We assessed high-sensitivity Troponin I (hs-cTnI), Creatine Kinase MB (CK-MB), C-reactive protein (CRP), procalcitonin (PCT), N-Terminal prohormone of brain natriuretic peptide (NTproBNP).
A final diagnosis of T1MI was assigned to 77 patients, T2MI to 60 patients, and NAMI to 76 patients; mean age was not significantly different between groups (73 vs. 71 years), female were more prevalent in the T2MI/NAMI group (53 % vs. 34 %, p < 0.01). Hs-cTnI peak/upper limit of normal (ULN) (559 ± 770 vs. 286 ± 429; p = 0.04), hs-cTnI peak/CRP ratio (114 ± 337 vs. 83 ± 430; p < 0.001), hs-cTnI peak/PCT ratio (12,592 ± 21,467 vs. 4,609 ± 17,284; p < 0.001), and hs-cTnI peak/NTproBNP ratio (0.7 ± 1.6 vs. 0.3 ± 0.6; p < 0.01) differentiated T1MI from T2MI Hs-cTnI peak/ULN (559 ± 770 vs. 271 ± 412; p < 0.01), hs-cTnI peak/PCT ratio (12,592 ± 21,468 vs. 3,570 ± 12,469; p < 0.001), hs-cTnI peak/NTproBNP ratio (0.7 ± 1.6 vs. 0.3 ± 1.3; p < 0.001) and hs-cTnI peak/CRP (114 ± 337 vs. 48 ± 288; p < 0.001) differentiated T1MI from T2MI + NAMI. Hs-cTnI peak/PCT ratio was a predictor of T1MI, a multivariable logistic regression analysis (OR 1.03, 95 % CI 1.01-1.06, p < 0.05) with an accuracy of 0.704 (95 % CI 0.626-0.782, p < 0.001). No significant differences between T2MI and NAMI were detected.
Admission biomarker profile may differentiate T1MI from T2MI in patients admitted for NSTEMI.
在入院时及住院期间区分1型心肌梗死（T1MI）和2型心肌梗死（T2MI）至关重要，以避免不必要的侵入性检查及不适当的急性心脏监护病房收治。
本研究旨在确定一种基于常用生物标志物的简单特征，以区分T1MI和T2MI。
我们前瞻性地纳入了一项观察性研究，连续213例因非ST段抬高型急性心肌梗死（NSTEMI）初步诊断而入住心内科的患者。根据临床和检查结果给出T1MI、T2MI和非缺血性急性心肌损伤（NAMI）的最终诊断。我们评估了高敏肌钙蛋白I（hs-cTnI）、肌酸激酶同工酶MB（CK-MB）、C反应蛋白（CRP）、降钙素原（PCT）、脑钠肽前体N末端（NTproBNP）。
最终诊断为T1MI的患者77例，T2MI的患者60例，NAMI的患者76例；各组间平均年龄无显著差异（73岁对71岁），女性在T2MI/NAMI组中更常见（53%对34%，p<0.01）。Hs-cTnI峰值/正常上限（ULN）（559±770对286±429；p=0.04）、hs-cTnI峰值/CRP比值（114±337对83±430；p<0.001）、hs-cTnI峰值/PCT比值（\(12,592\pm21,467\)对\(4,609\pm17,284\)；p<\(0.001\)）以及hs-cTnI峰值/NTproBNP比值（0.7±1.6对0.3±0.6；p<0.01）可区分T1MI和T2MI。Hs-cTnI峰值/ULN（559±770对271±412；p<0.01）、hs-cTnI峰值/PCT比值（\(12,592\pm21,468\)对\(3,570\pm12,469\)；p<\(0.001\)）、hs-cTnI峰值/NTproBNP比值（0.7±1.6对0.3±1.3；p<\(0.001\)）以及hs-cTnI峰值/CRP（114±337对48±288；p<\(0.001\)）可区分T1MI和T2MI+NAMI。Hs-cTnI峰值/PCT比值是T1MI的预测指标，多变量逻辑回归分析（OR 1.03，95%CI 1.01-1.06，p<0.05），准确率为0.704（95%CI 0.626-0.782，p<\(0.001\)）。未检测到T2MI和NAMI之间的显著差异。
入院时的生物标志物特征可在因NSTEMI入院的患者中区分T1MI和T2MI。
