A Plaque Disruption Index Identifies Patients with Non-STE-Type 1 Myocardial Infarction within 24 Hours of Troponin
Maha A Al-Mohaissen1, Ronald G Carere2, G B John Mancini3
1Department of Clinical Sciences, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia.
Insights
A novel plaque disruption index (PDI) using multiple biomarkers shows promise for diagnosing acute myocardial infarction (MI) within 24 hours of troponin elevation. This index offers higher specificity than individual markers and coronary angiography for identifying non-ST-elevation MI.
Area of Science:
- Cardiology
- Biomarker Discovery
- Diagnostic Accuracy
Background:
- Non-ST-elevation myocardial infarction (NSTEMI) diagnosis can be challenging with troponin elevation alone.
- Plaque destabilization markers may aid in identifying acute myocardial infarction (MI) type 1.
- A composite plaque disruption index (PDI) is hypothesized to improve diagnostic specificity.
Purpose of the Study:
- To evaluate the diagnostic performance of a PDI in patients with acute NSTEMI (NSTEMI-A).
- To compare the PDI's specificity against individual biomarkers and coronary angiography.
- To assess the PDI's utility within 24 hours of troponin positivity.
Main Methods:
- Examined myeloperoxidase (MPO), interleukin-6, myeloid-related protein 8/14 (MRP8/14), and pregnancy-associated plasma protein-A (PAPP-A).
- Calculated PDI in 83 patients across four groups: stable non-obstructive CAD, stable obstructive CAD, NSTEMI-A, and late NSTEMI (NSTEMI-L).
- Coronary angiograms were reviewed for plaque disruption, and diagnostic performance was compared.
Main Results:
- MPO demonstrated the highest specificity (83%) for NSTEMI-A among individual markers.
- The PDI (using PAPP-A, MRP8/14, MPO) was significantly higher in NSTEMI-A patients (p<0.001).
- PDI showed superior specificity (87%) and accuracy (86%) for NSTEMI-A compared to angiography (p<0.05).
Conclusions:
- A PDI measured within 24 hours of troponin positivity may identify acute non-ST-elevation type 1 MI.
- Further research with larger cohorts and varied marker combinations is needed.
- The PDI's role in differentiating type 1 and type 2 MI requires further investigation.
Background:
Markers of plaque destabilization and disruption may have a role in identifying non-STE- type 1 Myocardial Infarction in patients presenting with troponin elevation. We hypothesized that a plaque disruption index (PDI) derived from multiple biomarkers and measured within 24 hours from the first detectable troponin in patients with acute non-STE- type 1 MI (NSTEMI-A) will confirm the diagnosis and identify these patients with higher specificity when compared to individual markers and coronary angiography.
Methods:
We examined 4 biomarkers of plaque destabilization and disruption: myeloperoxidase (MPO), high-sensitivity interleukin-6, myeloid-related protein 8/14 (MRP8/14) and pregnancy-associated plasma protein-A (PAPP-A) in 83 consecutive patients in 4 groups: stable non-obstructive coronary artery disease (CAD), stable obstructive CAD, NSTEMI-A (enrolled within 24 hours of troponin positivity), and NSTEMI-L (Late presentation NSTEMI, enrolled beyond the 24 hour limit). The PDI was calculated and the patients' coronary angiograms were reviewed for evidence of plaque disruption. The diagnostic performance of the PDI and angiography were compared.
Results:
Compared to other biomarkers, MPO had the highest specificity (83%) for NSTEMI-A diagnosis (P<0.05). The PDI computed from PAPP-A, MRP8/14 and MPO was higher in NSTEMI-A patients compared to the other three groups (p<0.001) and had the highest diagnostic specificity (87%) with 79% sensitivity and 86% accuracy, which were higher compared to those obtained with MPO, but did not reach statistical significance (P>0.05 for all comparisons). The PDI had higher specificity and accuracy for NSTEMI-A diagnosis compared to coronary angiography (P<0.05).
Conclusions:
A PDI measured within 24 hour of troponin positivity has potential to identify subjects with acute Non-ST-elevation type 1 MI. Additional evidence using other marker combinations and investigation in a sufficiently large non-selected cohort is warranted to establish the diagnostic accuracy of the PDI and its potential role in differentiating type 1 and type 2 MI in patients presenting with troponin elevation of uncertain etiology.
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