一种基于生物标志物的评分系统，用于评估心肌梗死患者阻塞性冠状动脉疾病的存在情况

"A Biomarker-Based Scoring System to Assess the Presence of Obstructive Coronary Artery Disease in Patients With Myocardial Infarction".

作者信息

Espinosa Pascual María Jesús, Carnicero Carreño Jose Antonio, El Assar Mariam, Olsen Rodríguez Renee, Fraile Sanz Alfonso, Rodriguez Montes Paula, Gil Mancebo Nuria, Sánchez Ferrer Alberto, Izquierdo Coronel Bárbara, Álvarez Bello María, Martín Muñoz María, Cámara Hernández Verónica, de La Serna Real de Asua Miguel, Humanes Ybañez Silvia, Sosa Callejas Patricia, Gutierrez Muñoz Miguel, Mata Caballero Rebeca, Awamleh Garcia Paula, Perea Egido Jesús Ángel, López Pais Javier, Rodríguez Mañas Leocadio, Alonso Martín Joaquín Jesús

机构信息

Cardiology Department, Hospital Universitario Getafe, Getafe, Spain.

Department of Medicine, Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Spain.

出版信息

Clin Cardiol. 2025 Feb;48(2):e70090. doi: 10.1002/clc.70090.

DOI:10.1002/clc.70090

PMID:39967413

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11836528/

Abstract

AIMS

Approximately 10% of patients with myocardial infarction present with non-obstructive coronary arteries (MINOCA), whose characteristics differ from those with obstructive coronary lesions (MICAD). Inflammation plays a key role in myocardial infarction. This study aims to develop a biomarker-based index for accurate differentiation between MINOCA and MICAD.

METHODS

A prospective, observational cohort study including 111 patients admitted for myocardial infarction: 46 with MINOCA and 65 with MICAD. Blood samples were collected within the first 24 h to measure high-sensitivity C-reactive protein, interleukin-6, asymmetric dimethylarginine, and peak high-sensitivity troponin T. The association of these biomarkers with MICAD risk was analyzed using logistic regression. Scoring systems were developed using optimization algorithms to predict the diagnosis before coronary angiography, applied to both individual biomarkers and a combined index.

RESULTS

Patients had a mean age of 67 years (SD 13.3), with a male predominance (68.5%). Higher levels of IL-6 and high-sensitivity troponin T were significantly associated with increased MICAD risk (OR: 1.58; 95% CI: 1.01-2.46, and OR: 2.27; 95% CI: 1.61-3.26, respectively). As score increases, interleukin-6 and high-sensitivity troponin T increase the likelihood of MICAD classification, while higher asymmetric dimethylarginine levels reduce it. Each one-point increase in the combined index multiplies MICAD risk by six (OR:6.16, 95%CI: 2.72-13.95; p < 0.001). While individual indexes improved the diagnostic performance of biomarkers, the combined index demonstrated superior accuracy (AUC: 0.918).

CONCLUSIONS

A biomarker-based scoring system was developed, achieving superior discriminatory capacity for differentiating MINOCA from MICAD compared to the individual analysis of biomarkers in absolute values or independent indexes.

摘要

目的

约10%的心肌梗死患者表现为冠状动脉非阻塞性病变（MINOCA），其特征与冠状动脉阻塞性病变（MICAD）患者不同。炎症在心肌梗死中起关键作用。本研究旨在开发一种基于生物标志物的指数，以准确区分MINOCA和MICAD。

方法

一项前瞻性观察性队列研究，纳入111例因心肌梗死入院的患者：46例MINOCA患者和65例MICAD患者。在最初24小时内采集血样，检测高敏C反应蛋白、白细胞介素-6、不对称二甲基精氨酸和高敏肌钙蛋白T峰值。使用逻辑回归分析这些生物标志物与MICAD风险的关联。使用优化算法开发评分系统，以在冠状动脉造影前预测诊断，应用于单个生物标志物和综合指数。

结果

患者平均年龄67岁（标准差13.3），以男性为主（68.5%）。较高水平的白细胞介素-6和高敏肌钙蛋白T与MICAD风险增加显著相关（OR分别为：1.58；95%CI：1.01 - 2.46，以及OR：2.27；95%CI：1.61 - 3.26）。随着评分增加，白细胞介素-6和高敏肌钙蛋白T增加MICAD分类的可能性，而较高的不对称二甲基精氨酸水平则降低这种可能性。综合指数每增加1分，MICAD风险增加6倍（OR：6.16，95%CI：2.72 - 13.95；p < 0.001）。虽然单个指数提高了生物标志物的诊断性能，但综合指数显示出更高的准确性（AUC：0.918）。