Biomarkers distinguish types of myocardial infarction, injury

Seven of 29 biomarkers have been identified as the most applicable discriminators between subtypes of myocardial infarction (MI) or myocardial injury, a recent study has found. Additionally, regression models based on these biomarkers allow good discrimination.

This study sought to examine the discriminative value of a 29-biomarker panel in an emergency department (ED) setting. Patients who presented to the ED with suspected MI were enrolled. The final diagnosis in all participants was adjudicated based on the fourth universal definition of MI.

The authors measured a panel of 29 biomarkers and performed a multivariate logistic regression analysis to evaluate the associations of these biomarkers with the diagnosis of MI or myocardial injury. Backward selection was used to select biomarkers. The model was validated using bootstrapping.

In total, 748 patients (median age 64 years) were included in the study. Of these, 138 had MI (107 type 1 MI and 31 type 2 MI) and 221 had myocardial injury.

The multivariate model showed relevant discrimination between type 1 and type 2 MIs by four biomarkers, namely apolipoprotein A-II, N-terminal prohormone of brain natriuretic peptide, copeptin, and high-sensitivity cardiac troponin I. Internal validation of the model demonstrated an area under the curve of 0.82.

Moreover, six biomarkers were chosen for discrimination between MI and myocardial injury, namely adiponectin, N-terminal prohormone of brain natriuretic peptide, pulmonary and activation-regulated chemokine, transthyretin, copeptin, and high-sensitivity troponin I. Interval validation showed an area under the curve of 0.84.