Journal Article

A Biomarker‐Based Scoring System to Assess the Presence of Obstructive Coronary Artery Disease in Patients With Myocardial Infarction

Mata Caballero, Rebeca, Fraile Sanz, Alfonso, Rodríguez Mañas, Leocadio, El Assar, Mariam, La Serna Real de Asua, Miguel, Sosa Callejas, Patricia, Gil Mancebo, Nuria, Cámara Hernández, Verónica, Perea Egido, Jesús Ángel, Martín Muñoz, María, Humanes Ybañez, Silvia, Alonso Martín, Joaquín Jesús, Rodriguez Montes, Paula, López Pais, Javier, Izquierdo Coronel, Bárbara, Álvarez Bello, María, Awamleh Garcia, Paula, Olsen Rodríguez, Renee, Carnicero Carreño, Jose Antonio, Sánchez Ferrer, Alberto, Gutierrez Muñoz, Miguel, Espinosa Pascual, María Jesús

2025

Overview

ABSTRACT Aims Approximately 10% of patients with myocardial infarction present with non‐obstructive coronary arteries (MINOCA), whose characteristics differ from those with obstructive coronary lesions (MICAD). Inflammation plays a key role in myocardial infarction. This study aims to develop a biomarker‐based index for accurate differentiation between MINOCA and MICAD. Methods A prospective, observational cohort study including 111 patients admitted for myocardial infarction: 46 with MINOCA and 65 with MICAD. Blood samples were collected within the first 24 h to measure high‐sensitivity C‐reactive protein, interleukin‐6, asymmetric dimethylarginine, and peak high‐sensitivity troponin T. The association of these biomarkers with MICAD risk was analyzed using logistic regression. Scoring systems were developed using optimization algorithms to predict the diagnosis before coronary angiography, applied to both individual biomarkers and a combined index. Results Patients had a mean age of 67 years (SD 13.3), with a male predominance (68.5%). Higher levels of IL‐6 and high‐sensitivity troponin T were significantly associated with increased MICAD risk (OR: 1.58; 95% CI: 1.01–2.46, and OR: 2.27; 95% CI: 1.61–3.26, respectively). As score increases, interleukin‐6 and high‐sensitivity troponin T increase the likelihood of MICAD classification, while higher asymmetric dimethylarginine levels reduce it. Each one‐point increase in the combined index multiplies MICAD risk by six (OR:6.16, 95%CI: 2.72–13.95; p < 0.001). While individual indexes improved the diagnostic performance of biomarkers, the combined index demonstrated superior accuracy (AUC: 0.918). Conclusions A biomarker‐based scoring system was developed, achieving superior discriminatory capacity for differentiating MINOCA from MICAD compared to the individual analysis of biomarkers in absolute values or independent indexes. Summary What is known about the topic? ◦ Patients with MINOCA have distinct characteristics compared to those with MICAD, with inflammation and endothelial dysfunction potentially serving as key differentiators. ◦ High‐sensitivity troponin, commonly used in clinical practice for diagnosing myocardial infarction, is valuable but does not allow for precise differentiation between MINOCA and MICAD when used alone. ◦ The integration of inflammatory and endothelial dysfunction biomarkers with troponin in a scoring system could potentially provide a more accurate method for distinguishing between these two types of infarction. What's new? ◦ This study is the first to develop a scoring system using circulating biomarkers to more accurately differenciate between MINOCA and MICAD. ◦ We focused on four key biomarkers: IL‐6, hs‐CRP, ADMA and hs‐troponin T. By combining troponin T, which is widely used in MI diagnosis, with inflammatory and endothelial dysfunction biomarkers, our approach captures the complex underlying processes involved in myocardial infarction. ◦ Our study found that combining these biomarkers into a single index demonstrated outstanding diagnostic discrimination, significantly improving the identification of MI type compared to using individual biomarkers alone. ◦ This innovative scoring system has the potential to optimize MI patient management and guide treatment strategies more accurately. Comparison of diagnostic performance in detecting obstructive coronary artery disease in patients with myocardial infarction: the biomarker‐based index demonstrates outstanding discrimination compared to individual biomarker levels (ln BM) and individual índices (4BM). AUC values for models based on log‐transformed biomarkers (ln BM), individual indices, and the combined four‐biomarker index (4BM) are shown. Abbreviations: AUC = area under the curve; MICAD = Myocardial Infarction with Obstructive Coronary Artery Disease; MINOCA = Myocardial Infarction with Non‐Obstructive Coronary Arteries; MI = myocardial infarction; IL‐6 = Interleukin‐6, hs‐CRP = high‐sensitivity C‐reactive protein, ADMA = Asymmetric Dimethylarginine, hs‐troponin T = High‐sensitivity troponin T.

• Publisher: John Wiley & Sons, Inc,John Wiley and Sons Inc
• Subject: Aged / Arginine - analogs & derivatives / Arginine - blood / Biomarkers / Biomarkers - blood / C-Reactive Protein - analysis / C-Reactive Protein - metabolism / Cardiovascular disease / Clinical / Coronary Angiography / Coronary Artery Disease - blood / Coronary Artery Disease - complications / Coronary Artery Disease - diagnosis / Coronary Artery Disease - diagnostic imaging / Coronary vessels / diagnosis / endothelial dysfunction / Female / Heart attacks / Heart failure / Hospitalization / Humans / index / Inflammation / Inflammation Mediators - blood / Interleukin-6 - blood / Logistic Models / Male / Medical imaging / MICAD / Middle Aged / MINOCA / MINOCA - blood / MINOCA - diagnosis / MINOCA - diagnostic imaging / Mortality / myocardial infarction / Myocardial Infarction - blood / Myocardial Infarction - diagnosis / Myocardial Infarction - etiology / Odds Ratio / Predictive Value of Tests / Prospective Studies / Risk Factors / ROC Curve / score / Transient ischemic attack / Troponin T - blood / Variables / Vein & artery diseases