Biomarker profiles that differentiate type-1 and type 2 myocardial infarction.

IF 2.4 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Heart & Lung Pub Date : 2025-01-02 DOI:10.1016/j.hrtlng.2024.12.008

Marco Mele, Francesco Mautone, Ilaria Ragnatela, Damiano D'Alessandro, Luciano Umberto Rossi, Michele Granatiero, Gianpaolo Palmieri, Laura Giannetti, Davide Diomede, Antonietta Mele, Antonella Liantonio, Paola Imbrici, Michele Correale, Francesco Santoro, Maria Delia Corbo, Enrica Vitale, Michele Magnesa, Natale Daniele Brunetti

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Abstract

Background: 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.

Objectives: The purpose of the study was to define a simple profile derived from commonly used biomarkers to differentiate T1MI from T2MI.

Methods: 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).

Results: 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.

Conclusions: Admission biomarker profile may differentiate T1MI from T2MI in patients admitted for NSTEMI.

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来源期刊

Heart & Lung 医学-呼吸系统

CiteScore

4.60

自引率

3.60%

发文量

184

审稿时长

35 days

期刊介绍： Heart & Lung: The Journal of Cardiopulmonary and Acute Care, the official publication of The American Association of Heart Failure Nurses, presents original, peer-reviewed articles on techniques, advances, investigations, and observations related to the care of patients with acute and critical illness and patients with chronic cardiac or pulmonary disorders. The Journal''s acute care articles focus on the care of hospitalized patients, including those in the critical and acute care settings. Because most patients who are hospitalized in acute and critical care settings have chronic conditions, we are also interested in the chronically critically ill, the care of patients with chronic cardiopulmonary disorders, their rehabilitation, and disease prevention. The Journal''s heart failure articles focus on all aspects of the care of patients with this condition. Manuscripts that are relevant to populations across the human lifespan are welcome.