Original Investigation
A Biomarker Model to Distinguish Types of Myocardial Infarction and Injury

https://doi.org/10.1016/j.jacc.2021.06.027Get rights and content
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Abstract

Background

Discrimination among patients with type 1 myocardial infarction (T1MI), type 2 myocardial infarction (T2MI), and myocardial injury is difficult.

Objectives

The aim of this study was to investigate the discriminative value of a 29-biomarker panel in an emergency department setting.

Methods

Patients presenting with suspected myocardial infarction (MI) were recruited. The final diagnosis in all patients was adjudicated on the basis of the fourth universal definition of MI. A panel of 29 biomarkers was measured, and multivariable logistic regression analysis was used to evaluate the associations of these biomarkers with the diagnosis of MI or myocardial injury. Biomarkers were chosen using backward selection. The model was internally validated using bootstrapping.

Results

Overall, 748 patients were recruited (median age 64 years), of whom 138 had MI (107 T1MI and 31 T2MI) and 221 had myocardial injury. In the multivariable model, 4 biomarkers (apolipoprotein A-II, N-terminal prohormone of brain natriuretic peptide, copeptin, and high-sensitivity cardiac troponin I) remained significant discriminators between T1MI and T2MI. Internal validation of the model showed an area under the curve of 0.82. For discrimination between MI and myocardial injury, 6 biomarkers (adiponectin, N-terminal prohormone of brain natriuretic peptide, pulmonary and activation-regulated chemokine, transthyretin, copeptin, and high-sensitivity troponin I) were selected. Internal validation showed an area under the curve of 0.84.

Conclusions

Among 29 biomarkers, 7 were identified to be the most relevant discriminators between subtypes of MI or myocardial injury. Regression models based on these biomarkers allowed good discrimination. (Biomarkers in Acute Cardiac Care [BACC]; NCT02355457)

Key Words

acute coronary syndrome
biomarker
copeptin
myocardial infarction
myocardial injury
NT-proBNP
troponin
type 1
type 2

Abbreviations and Acronyms

Apo
apolipoprotein
AUC
area under the curve
CI
confidence interval
CRP
C-reactive protein
FABP
fatty acid–binding protein
hs-cTnI
high-sensitivity cardiac troponin I
MI
myocardial infarction
NT-proBNP
N-terminal prohormone of brain natriuretic peptide
OR
odds ratio
PARC
pulmonary and activation-regulated chemokine
RANTES
regulated upon activation, normal T cell expressed and presumably secreted
TNFR2
tumor necrosis factor receptor 2

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