Early Identification of ST-Segment Elevation Myocardial Infarction (STEMI) at Presentation: Comparative Diagnostic
Chennet Phonphet1, Putrada Ninla-Aesong2, Sasithorn Sanakus3
1School of Nursing and the Excellent Center of Community Health Promotion, Walailak University, Nakhon Si Thammarat 80160, Thailand.
Insights
Complete blood count (CBC)-derived inflammatory indices, like neutrophil-to-lymphocyte platelet ratio (NLPR), show promise for early ST-segment elevation myocardial infarction (STEMI) detection when high-sensitivity troponin T is less sensitive. These markers may aid initial diagnosis in acute coronary syndrome (ACS) patients.
Area of Science:
- Cardiology
- Clinical Diagnostics
- Biomarker Research
Background:
- Early identification of ST-segment elevation myocardial infarction (STEMI) is crucial but challenging due to limitations of high-sensitivity troponin T in the initial phase.
- Complete blood count (CBC)-derived inflammatory indices offer potential complementary early diagnostic signals.
Purpose of the Study:
- To evaluate differences in baseline CBC-derived inflammatory indices between STEMI and NSTEMI patients.
- To assess the adjunctive discriminatory value of these indices at presentation in acute coronary syndrome (ACS) patients.
Main Methods:
- Analysis of 12-lead ECG, high-sensitivity troponin T, and CBC in 252 ACS patients (195 STEMI, 57 NSTEMI).
- Receiver operating characteristic (ROC) curve analysis to determine diagnostic performance metrics (AUC, sensitivity, specificity, PPV, NPV, likelihood ratios).
Main Results:
- High-sensitivity troponin T showed high specificity but low sensitivity and NPV for early assessment.
- White blood cell (WBC) and neutrophil counts demonstrated favorable discrimination (AUC > 0.72).
- Neutrophil-to-lymphocyte platelet ratio (NLPR) exhibited high sensitivity (88.66%) and NPV (53.19%), with a low negative likelihood ratio (0.25), suggesting adjunctive value.
Conclusions:
- CBC-derived inflammatory indices, especially neutrophil-based markers like NLPR, can provide valuable adjunctive information in the early assessment of ACS.
- These markers are particularly useful at first medical contact when hs-Troponin T sensitivity may be limited.
Abstract:
Background/Objectives: Early identification of ST-segment elevation myocardial infarction (STEMI) at first medical contact remains challenging, as high-sensitivity troponin T may be insufficiently sensitive during the initial phase of myocardial injury. Readily available complete blood count (CBC)-derived inflammatory indices may provide complementary early diagnostic signals. This study aimed to evaluate whether baseline CBC-derived inflammatory indices differ between STEMI and NSTEMI and whether they provide adjunctive discriminatory information at presentation (0 h) in patients with acute coronary syndrome (ACS). Methods: A 12-lead electrocardiogram (ECG), high-sensitivity troponin T, and CBC were obtained at presentation from 252 patients with ACS (195 STEMI and 57 NSTEMI). Diagnostic performance was evaluated using receiver operating characteristic (ROC) curve analysis and 2 × 2 contingency tables to determine the area under the curve (AUC), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and likelihood ratios. Results: High-sensitivity troponin T demonstrated the highest specificity (84.44%) and PPV (92.93%), supporting its role as a confirmatory biomarker; however, its low sensitivity (50.83%) and NPV (29.92%) may reduce its utility during early assessment. In contrast, WBC and neutrophil counts demonstrated relatively favorable discriminatory performance at presentation (AUC > 0.72; Youden's index > 0.40). Among composite indices, NLPR demonstrated the highest sensitivity (88.66%) and NPV (53.19%), along with the lowest negative likelihood ratio (0.25), suggesting potential adjunctive value during early assessment. NLR, SII, SIRI, and adjusted NLR showed moderate performance, with aNLR providing a balanced sensitivity (67.01%) and specificity (74.55%). Conclusions: CBC-derived inflammatory indices, particularly neutrophil-based markers such as NLPR, may provide adjunctive discriminatory information during the early assessment of patients with ACS, particularly at first medical contact when baseline hs-Troponin T sensitivity may still be limited.
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