非ST段抬高型急性冠脉综合征早期miRNA-499水平升高预示主要不良心脏事件的长期风险增加。
Elevated miRNA-499 Levels in Early Phase of Non-ST Elevation Acute Coronary Syndromes Predict Increased Long-Term Risk of Major Adverse Cardiac Events.
作者信息
Miśkowiec Dawid, Szymczyk Ewa, Wejner-Mik Paulina, Michalski Błażej, Lipiec Piotr, Simiera Michał, Kupczyńska Karolina, Kasprzak Jarosław D
机构信息
Department of Cardiology, Medical University of Lodz, Kniaziewicza Street 1/5, 91-347 Lodz, Poland.
出版信息
J Clin Med. 2024 Dec 20;13(24):7803. doi: 10.3390/jcm13247803.
: Available data suggest the diagnostic potential of testing microRNAs (miRs) in myocardial infarction, but their prognostic value remains unclear. To evaluate the prognostic value of circulating miRs (miR-1, miR-21, miR-133a, miR-208 and miR-499) for predicting major adverse cardiac events (MACEs), including death, non-fatal myocardial infarction (MI) or cardiovascular rehospitalization, in patients with non-ST segment elevation acute coronary syndromes (NSTE-ACS). Our prospective, single-center, observational study included patients (pts) with NSTE-ACS admitted <24 h after symptoms onset and pts with confirmed stable coronary artery disease (SCAD) as controls. Relative expression of miRs was calculated, and subjects were categorized according to miRs expression on hospital admission into two groups (≤median and >median). Overall, 103 NSTE-ACS (52 NSTEMI/51 UA) and 47 SCAD pts (median age 66 years, 67% male) were included. During the median 895 (581-1134) days of the follow-up, MACE occurred in 75 (50%) patients: 20 (13%) died, 28 (19%) presented with MI, and 65 (43%) were readmitted due to cardiovascular reasons. Incidence of MI, rehospitalization and MACE was significantly higher in pts with elevated (>median) miR-499 [MI: 34.3% vs. 7.3%; HR = 6.0 (2.8-12.7) for rehospitalization; 53.7% vs. 36.2%, HR = 2.3 (1.4-3.8) for MACE; 62.7% vs. 42%, HR = 2.4 (1.5-3.8)] for hospital readmission. In the Cox proportional hazards regression model, miR-499 expression above the median level [HR = 1.8 (1.1-3.1)], high-sensitivity cardiac troponin T [HR = 1.2 (1.02-1.5)], diabetes [HR = 1.7 (1.1-2.8)] and percutaneous intervention during hospital stay [HR = 2.1 (1.1-3.8)] were identified as independent predictors of MACE in long-term observation, even after adjustment for covariates. Elevated miR-499 level on hospital admission in NSTE-ACS is related to an increased rate of MACE in the 2.5-year follow-up.
现有数据提示检测微小RNA（miR）在心肌梗死中具有诊断潜力，但其预后价值仍不明确。为评估循环miR（miR-1、miR-21、miR-133a、miR-208和miR-499）对预测非ST段抬高急性冠状动脉综合征（NSTE-ACS）患者主要不良心脏事件（MACE）的预后价值，MACE包括死亡、非致死性心肌梗死（MI）或心血管原因再住院。我们的前瞻性、单中心观察性研究纳入症状发作后<24小时入院的NSTE-ACS患者（pts）以及确诊的稳定冠状动脉疾病（SCAD）患者作为对照。计算miR的相对表达，并根据入院时miR表达将受试者分为两组（≤中位数和>中位数）。总体而言，纳入了103例NSTE-ACS患者（52例非ST段抬高心肌梗死/51例不稳定型心绞痛）和47例SCAD患者（中位年龄66岁，67%为男性）。在中位895（581-1134）天的随访期间，75例（50%）患者发生了MACE：20例（13%）死亡，28例（19%）发生MI，65例（43%）因心血管原因再次入院。miR-499升高（>中位数）的患者MI、再住院和MACE的发生率显著更高[MI：34.3%对7.3%；再住院的风险比（HR）=6.0（2.8-12.7）；MACE：53.7%对36.2%，HR=2.3（1.4-3.8）]。在Cox比例风险回归模型中，即使在调整协变量后，入院时miR-499表达高于中位数水平[HR=1.8（1.1-3.1）]、高敏心肌肌钙蛋白T[HR=1.2（1.02-1.5）]、糖尿病[HR=1.7（1.1-2.8）]以及住院期间的经皮介入治疗[HR=2.1（1.1-3.8）]被确定为长期观察中MACE的独立预测因素。NSTE-ACS患者入院时miR-499水平升高与2.5年随访期间MACE发生率增加相关。
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