《基于生物标志物的评分系统评估心肌梗死患者是否存在阻塞性冠状动脉疾病》

IF 2.3 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
María Jesús Espinosa Pascual, Jose Antonio Carnicero Carreño, Mariam El Assar, Renee Olsen Rodríguez, Alfonso Fraile Sanz, Paula Rodriguez Montes, Nuria Gil Mancebo, Alberto Sánchez Ferrer, Bárbara Izquierdo Coronel, María Álvarez Bello, María Martín Muñoz, Verónica Cámara Hernández, Miguel de La Serna Real de Asua, Silvia Humanes Ybañez, Patricia Sosa Callejas, Miguel Gutierrez Muñoz, Rebeca Mata Caballero, Paula Awamleh Garcia, Jesús Ángel Perea Egido, Javier López Pais, Leocadio Rodríguez Mañas, Joaquín Jesús Alonso Martín
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引用次数: 0

摘要

目的:大约10%的心肌梗死患者存在非阻塞性冠状动脉(MINOCA),其特征不同于阻塞性冠状动脉病变(MICAD)。炎症在心肌梗死中起关键作用。本研究旨在建立基于生物标志物的MINOCA和MICAD准确鉴别指标。方法一项前瞻性、观察性队列研究,纳入111例心肌梗死患者:46例MINOCA, 65例MICAD。在最初的24小时内采集血样,测量高敏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的峰值。使用logistic回归分析这些生物标志物与MICAD风险的相关性。使用优化算法开发了评分系统,用于预测冠状动脉造影前的诊断,适用于个体生物标志物和综合指数。结果患者平均年龄67岁(SD 13.3),男性居多(68.5%)。高水平的IL-6和高敏感性肌钙蛋白T与MICAD风险增加显著相关(OR: 1.58;95% CI: 1.01-2.46, OR: 2.27;95% CI分别为1.61-3.26)。随着评分的增加,白细胞介素-6和高敏感性肌钙蛋白T增加了MICAD分类的可能性,而较高的不对称二甲基精氨酸水平降低了MICAD分类的可能性。综合指数每增加1点,MICAD风险增加6倍(OR:6.16, 95%CI: 2.72-13.95;p < 0.001)。虽然单个指标提高了生物标志物的诊断性能,但联合指标具有更高的准确性(AUC: 0.918)。结论建立了基于生物标志物的评分系统,与单独分析生物标志物的绝对值或独立指标相比,该评分系统具有更好的区分MINOCA和MICAD的能力。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

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

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

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.

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来源期刊
Clinical Cardiology
Clinical Cardiology 医学-心血管系统
CiteScore
5.10
自引率
3.70%
发文量
189
审稿时长
4-8 weeks
期刊介绍: Clinical Cardiology provides a fully Gold Open Access forum for the publication of original clinical research, as well as brief reviews of diagnostic and therapeutic issues in cardiovascular medicine and cardiovascular surgery. The journal includes Clinical Investigations, Reviews, free standing editorials and commentaries, and bonus online-only content. The journal also publishes supplements, Expert Panel Discussions, sponsored clinical Reviews, Trial Designs, and Quality and Outcomes.
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