Novel biomarkers help discriminate type 2 MI from type 1 MI in noninvasive manner

It was an international, multicenter prospective diagnostic study of 5887 patients with acute chest discomfort in the emergency departments. The researchers evaluated the discrimination of hs-cTn T, hs-cTn I, and 17 novel cardiovascular biomarkers measured in subsets of consecutively enrolled patients against a reference standard (final diagnosis), centrally adjudicated by 2 independent cardiologists according to the fourth universal definition of MI, using all information, including cardiac imaging and serial measurements of hs-cTnT or hs-cTnI.

Key findings of the study were:

• Among 5,887 eligible patients, 1,106 (18.8%) had an adjudicated final diagnosis of MI and, of these, 246 patients (22.2%) had T2MI and 860 (77.8%) had T1MI.
• Upon analysis, the researchers found that most biomarkers had "comparable concentrations" in T1MI and T2MI, limiting their usefulness to differentiate one from the other
• They also found four novel biomarkers (MR-proANP, CT-proET-1, midregional proadrenomedullin, and GDF 15) were higher in T2MI vs T1MI and showed modest promise for the early discrimination of T2MI.
• They noted that none of the tested cardiovascular biomarkers had significantly higher diagnostic discrimination. However, upon multivariable regression analysis, they noted a possible additive value of MR-proANP to clinical variables.

The authors concluded, " In this study, biomarkers quantifying myocardial injury, endothelial dysfunction, microvascular dysfunction, and/or hemodynamic stress provided modest discrimination in early, noninvasive diagnosis of T2MI."

For further information:

https://jamanetwork.com/journals/jamacardiology/article-abstract/2778579