Differences in biomarker concentrations and predictions of long-term outcome in patients with ST-elevation and
Marcus Hjort1, Kai M Eggers2, Lars Lindhagen3
1Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden; Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
Insights
Biomarkers reveal distinct acute phase differences between ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI). However, these biomarkers showed similar long-term prognostic value for adverse events in both heart attack types.
Area of Science:
- Cardiology
- Biomarker Discovery
- Translational Medicine
Background:
- Understanding differences in pathobiology and prognosis between ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) is crucial for optimizing patient treatment.
- Current knowledge on distinct biomarkers reflecting pathobiology and prognosis in STEMI versus NSTEMI is incomplete.
Purpose of the Study:
- To identify and evaluate biomarkers that differentiate STEMI from NSTEMI.
- To assess the prognostic value of these discriminatory biomarkers for adverse cardiovascular events in STEMI and NSTEMI patients.
Main Methods:
- A registry-based study analyzed 175 biomarkers in 538 STEMI and 544 NSTEMI patients using Proximity Extension Assay and mass spectrometry.
- Adjusted Lasso analysis identified biomarkers distinguishing STEMI from NSTEMI.
- Cox regression models assessed biomarker associations with death or major adverse cardiovascular events.
Main Results:
- Eleven biomarkers independently discriminated STEMI from NSTEMI, with seven higher in STEMI (e.g., myoglobin, NT-proBNP, IL-6) and four higher in NSTEMI (e.g., FGF23, ApoC-I).
- Biomarkers indicated greater myocardial dysfunction and inflammation in acute STEMI compared to NSTEMI.
- None of the identified biomarkers showed differential prognostic associations with adverse outcomes between STEMI and NSTEMI during follow-up.
Conclusions:
- Distinct acute phase biomarker profiles exist for STEMI and NSTEMI, reflecting differences in myocardial dysfunction and inflammation.
- The evaluated biomarkers demonstrated similar prognostic capabilities for adverse events in both STEMI and NSTEMI patients.
- Current findings do not support differential treatment strategies for STEMI and NSTEMI based on the measured acute phase biomarkers.
Background:
Differences in biomarkers reflective of pathobiology and prognosis between ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) are incompletely understood and may offer insights for tailoring of treatment.
Methods:
This registry-based study included 538 STEMI and 544 NSTEMI patients admitted 2008-2014. Blood samples were collected day 1-3 after admission and 175 biomarkers were analyzed using Proximity Extension Assay and Multiple Reaction Monitoring mass spectrometry. Adjusted Lasso analysis (penalized logistic regression model) was used to select biomarkers that discriminated STEMI from NSTEMI patients. Biomarkers identified by the Lasso analysis were then evaluated in adjusted Cox regressions for associations with death or major adverse cardiovascular events.
Results:
Biomarkers strongly discriminated STEMI and NSTEMI when considered simultaneously in adjusted Lasso analysis (c-statistic 0.764). Eleven biomarkers independently discriminated STEMI and NSTEMI; seven showing higher concentrations in STEMI: myoglobin, N-terminal pro-B-type natriuretic peptide, serum amyloid A-1 and A-2 protein, ST2 protein, interleukin-6 and chitinase-3-like protein 1; and four showing higher concentrations in NSTEMI: fibroblast growth factor 23, membrane-bound aminopeptidase P, tumor necrosis factor-related activation-induced cytokine and apolipoprotein C-I. During up to 6.6 years of prognostic follow-up, none of these biomarkers exhibited different associations with adverse outcome between STEMI and NSTEMI.
Conclusions:
In the acute setting, biomarkers indicated greater myocardial dysfunction and inflammation in STEMI, whereas they displayed a more diverse pathophysiologic pattern in NSTEMI patients. These biomarkers were similarly prognostic in STEMI and NSTEMI patients. The results do not support treating STEMI and NSTEMI patients differently based on the concentrations of these biomarkers.
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