Diagnostic and prognostic value of circulating microRNAs in patients with acute chest pain

作者：Devaux Y^*; Mueller M; Haaf P; Goretti E; Twerenbold R; Zangrando J; Vausort M; Reichlin T; Wildi K; Moehring B; Wagner D R; Mueller C

来源：Journal of Internal Medicine, 2015, 277(2): 260-271.

DOI：10.1111/joim.12183

• acute myocardial infarction
• biomarker
• chest pain
• diagnosis
• microRNAs
• prognosis

ObjectivesTo address the diagnostic value of circulating microRNAs (miRNAs) in patients presenting with acute chest pain.
DesignIn a prospective, international, multicentre study, six miRNAs (miR-133a, miR-208b, miR-223, miR-320a, miR-451 and miR-499) were simultaneously measured in a blinded fashion in 1155 unselected patients presenting with acute chest pain to the emergency department. The final diagnosis was adjudicated by two independent cardiologists. The clinical follow-up period was 2years.
ResultsAcute myocardial infarction (AMI) was the adjudicated final diagnosis in 224 patients (19%). Levels of miR-208b, miR-499 and miR-320a were significantly higher in patients with AMI compared to those with other final diagnoses. MiR-208b provided the highest diagnostic accuracy for AMI (area under the receiver operating characteristic curve 0.76, 95% confidence interval 0.72-0.80). This diagnostic value was lower than that of the fourth-generation cardiac troponin T (cTnT; 0.84) or the high-sensitivity cTnT (hs-cTnT; 0.94; both P<0.001 for comparison). None of the six miRNAs provided added diagnostic value when combined with cTnT or hs-cTnT (ns for the comparison of combinations vs. cTnT or hs-cTnT alone). During follow-up, 102 (9%) patients died. Levels of MiR-208b were higher in patients who died within 30days, but the prognostic accuracy was low to moderate. None of the miRNAs predicted long-term mortality.
ConclusionThe miRNAs investigated in this study do not seem to provide incremental diagnostic or prognostic value in patients presenting with suspected AMI.

• 出版日期2015-2