Biomarker assessment for early infarct size estimation in ST-elevation myocardial infarction

Abstract

Background: High-sensitivity cardiac troponin T (hs-cTnT) represents the biomarker of choice for infarct size (IS) estimation in patients with acute ST-elevation myocardial infarction (STEMI). However, admission values of hs-cTnT are only weakly associated with IS. The aim of this study was to investigate the incremental value of different biomarkers measured on admission for IS estimation in STEMI patients. Methods: In this prospective observational study, we included 161 consecutive STEMI patients treated with primary percutaneous coronary intervention (pPCI). The following biomarkers were assessed on admission: hs-cTnT, N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) and neutrophil/lymphocyte ratio (NLR). IS was determined by cardiac magnetic resonance (CMR) imaging 3 (Interquartile range [IQR] 2 to 4) days after the index event. Results: Patients with large IS (> 19% of left ventricular myocardium) showed significantly higher levels of admission hs-cTnT (399.6 vs. 53.4 ng/L, p < .001), NT-pro-BNP (140 vs. 86 ng/L, p = .008) and NLR (6.4 vs. 4.1, p < .001). The combination of hs-cTnT, NT-pro-BNP and NLR on admission resulted in a significantly higher area under the curve (0.78; 95% CI 0.704 to 0.838, (p = .01)) for the prediction of large IS than admission hs-cTnT alone (0.69; 95% CI 0.619 to 0.767). Conclusions: In STEMI patients undergoing pPCI, a comprehensive biomarker approach on admission including hs-cTnT, NT-pro-BNP and NLR was significantly better for immediate infarct severity estimation as compared to hs-cTnT alone.

Neutrophil extracellular traps and dsDNA predict outcomes among patients with ST-elevation myocardial infarction

“…Meanwhile, time-concentration curves and their changes for the plasma levels of total CK, CK-MB from time of enrollment to 110 h have been displayed (Fig. 4A,B), which was commonly used in evaluating the degree of myocardial necrosis in clinical practice and associated with adverse clinical outcomes 13–15 . The curves for CK, CK-MB reached peak levels by 6 to 12 h, and decreased steadily thereafter.…”

“…In a multivariate regression model, coronary dsDNA remained an independent correlation with in-hospital MACEs. In addition, we explored the association between the change of CK-MB and AUC CK-MB, which commonly used in evaluating the degree of myocardial necrosis in clinical practice and associated with adverse clinical outcomes 13–15 , and NETs (dsDNA, MPO/DNA). Although, there was no correction been found, coronary dsDNA was more sensitive than other conventional prognostic markers, such as troponin T and CK-MB.…”

Kinetics, Moderators and Reference Limits of Exercise-Induced Elevation of Cardiac Troponin T in Athletes: A Systematic Review and Meta-Analysis

“…The increase in hs-cTnT following exercise in the present meta-analysis was similar in pattern to that of early release kinetics observed in a clinical setting (Thygesen et al, 2018), but the peak concentration was much lower (33 ng.L −1 ) and the recovery was earlier in our meta-analysis compared with clinical conditions. As a quantitative marker of cardiomyocyte injury, the more pronounced the change of hs-cTnT, the higher the likelihood of cardiac injury (Marjot et al, 2017;Tiller et al, 2019). Concentrations lower than 50 ng L −1 were considered to represent micro myocardial infarction, chronic heart disease, or non-myocardial infarction conditions, such as kidney disease (Kozinski et al, 2017).…”

From Classic to Modern Prognostic Biomarkers in Patients with Acute Myocardial Infarction

“…Therefore, it can be considered a predictive biomarker for all-cause and cause-specific mortality [ 60 ]. According to Tiller et al, in patients with STEMI undergoing primary PCI, the levels of NT-proBNP at admission were increased in those with an infarct size greater than 19% of the LV myocardium as evaluated by cardiac magnetic resonance imaging in comparison with those with a smaller affected area (140 ng/L vs. 86 ng/L, p = 0.008), an early assessment of the amount of the cardiac damage being an essential instrument for post-STEMI risk stratification [ 61 ]. Celebi et al [ 62 ] showed that a single determination of NT-proBNP levels being greater than 400 pg/dL within 12 h offers a predictive value for LV aneurysm (LVA) development.…”