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

Area of Science:

• Cardiology
• Biomarker Research
• Medical Imaging

Background:

• High-sensitivity cardiac troponin T (hs-cTnT) is the preferred biomarker for estimating infarct size (IS) in ST-elevation myocardial infarction (STEMI).
• Admission hs-cTnT levels show only a weak correlation with IS.
• There is a need to explore additional biomarkers for improved IS estimation in STEMI patients.

Purpose of the Study:

• To investigate the incremental value of admission biomarkers, including hs-cTnT, NT-pro-BNP, and NLR, for estimating IS in STEMI patients.
• To compare the predictive performance of a multi-biomarker approach against hs-cTnT alone for large IS.
• To assess the utility of these biomarkers in patients undergoing primary percutaneous coronary intervention (pPCI).

Main Methods:

• Prospective observational study including 161 STEMI patients treated with pPCI.
• Assessment of admission biomarkers: hs-cTnT, N-terminal pro-B-type natriuretic peptide (NT-pro-BNP), and neutrophil/lymphocyte ratio (NLR).
• Infarct size (IS) determined by cardiac magnetic resonance (CMR) imaging 3 days post-event.

Main Results:

• Patients with large IS (>19% LV myocardium) had significantly higher admission levels of hs-cTnT, NT-pro-BNP, and NLR.
• The combination of hs-cTnT, NT-pro-BNP, and NLR demonstrated a significantly higher area under the curve (0.78) for predicting large IS compared to hs-cTnT alone (0.69).
• The multi-biomarker panel showed superior predictive accuracy for infarct severity.

Conclusions:

• In STEMI patients undergoing pPCI, a combined biomarker approach using hs-cTnT, NT-pro-BNP, and NLR on admission significantly enhances infarct severity estimation.
• This comprehensive strategy is more effective than relying solely on admission hs-cTnT levels.
• The findings support the use of a multi-biomarker panel for early and accurate assessment of infarct size in STEMI.