A plaque disruption index identifies patients with non-STE-type 1 myocardial infarction within 24 hours of troponin positivity

Maha A. Al-Mohaissen, Ronald G. Carere, G. B.John Mancini, Karin H. Humphries, Beth A. Whalen, Terry Lee, Frank X. Scheuermeyer, Andrew P. Ignaszewski

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Abstract

Background Markers of plaque destabilization and disruption may have a role in identifying non-STEtype 1 Myocardial Infarction in patients presenting with troponin elevation. We hypothesized that a plaque disruption index (PDI) derived from multiple biomarkers and measured within 24 hours from the first detectable troponin in patients with acute non-STE- type 1 MI (NSTEMI-A) will confirm the diagnosis and identify these patients with higher specificity when compared to individual markers and coronary angiography. Methods We examined 4 biomarkers of plaque destabilization and disruption: myeloperoxidase (MPO), high-sensitivity interleukin-6, myeloid-related protein 8/14 (MRP8/14) and pregnancy- associated plasma protein-A (PAPP-A) in 83 consecutive patients in 4 groups: stable non-obstructive coronary artery disease (CAD), stable obstructive CAD, NSTEMI-A (enrolled within 24 hours of troponin positivity), and NSTEMI-L (Late presentation NSTEMI, enrolled beyond the 24 hour limit). The PDI was calculated and the patients' coronary angiograms were reviewed for evidence of plaque disruption. The diagnostic performance of the PDI and angiography were compared. Results Compared to other biomarkers, MPO had the highest specificity (83%) for NSTEMI-A diagnosis (P<0.05). The PDI computed from PAPP-A, MRP8/14 and MPO was higher in NSTEMI-A patients compared to the other three groups (P<0.001) and had the highest diagnostic specificity (87%) with 79% sensitivity and 86% accuracy, which were higher compared to those obtained with MPO, but did not reach statistical significance (P>0.05 for all comparisons). The PDI had higher specificity and accuracy for NSTEMI-A diagnosis compared to coronary angiography (P<0.05). Conclusions A PDI measured within 24 hour of troponin positivity has potential to identify subjects with acute Non-ST-elevation type 1 MI. Additional evidence using other marker combinations and investigation in a sufficiently large non-selected cohort is warranted to establish the diagnostic accuracy of the PDI and its potential role in differentiating type 1 and type 2 MI in patients presenting with troponin elevation of uncertain etiology.

Original languageEnglish
Article numbere0164315
JournalPLoS ONE
Volume11
Issue number10
DOIs
Publication statusPublished - 1 Oct 2016

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troponins
Troponin
myocardial infarction
Myocardial Infarction
Angiography
Biomarkers
biomarkers
myeloperoxidase
Peroxidase
Coronary Angiography
Coronary Artery Disease
Pregnancy-Associated Plasma Protein-A
Interleukin-6
interleukin-6
blood proteins
etiology
Non-ST Elevated Myocardial Infarction
pregnancy
Proteins
proteins

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Al-Mohaissen, M. A., Carere, R. G., Mancini, G. B. J., Humphries, K. H., Whalen, B. A., Lee, T., ... Ignaszewski, A. P. (2016). A plaque disruption index identifies patients with non-STE-type 1 myocardial infarction within 24 hours of troponin positivity. PLoS ONE, 11(10), [e0164315]. https://doi.org/10.1371/journal.pone.0164315
Al-Mohaissen, Maha A. ; Carere, Ronald G. ; Mancini, G. B.John ; Humphries, Karin H. ; Whalen, Beth A. ; Lee, Terry ; Scheuermeyer, Frank X. ; Ignaszewski, Andrew P. / A plaque disruption index identifies patients with non-STE-type 1 myocardial infarction within 24 hours of troponin positivity. In: PLoS ONE. 2016 ; Vol. 11, No. 10.
@article{4179ac54698f4525a755638f0cb15375,
title = "A plaque disruption index identifies patients with non-STE-type 1 myocardial infarction within 24 hours of troponin positivity",
abstract = "Background Markers of plaque destabilization and disruption may have a role in identifying non-STEtype 1 Myocardial Infarction in patients presenting with troponin elevation. We hypothesized that a plaque disruption index (PDI) derived from multiple biomarkers and measured within 24 hours from the first detectable troponin in patients with acute non-STE- type 1 MI (NSTEMI-A) will confirm the diagnosis and identify these patients with higher specificity when compared to individual markers and coronary angiography. Methods We examined 4 biomarkers of plaque destabilization and disruption: myeloperoxidase (MPO), high-sensitivity interleukin-6, myeloid-related protein 8/14 (MRP8/14) and pregnancy- associated plasma protein-A (PAPP-A) in 83 consecutive patients in 4 groups: stable non-obstructive coronary artery disease (CAD), stable obstructive CAD, NSTEMI-A (enrolled within 24 hours of troponin positivity), and NSTEMI-L (Late presentation NSTEMI, enrolled beyond the 24 hour limit). The PDI was calculated and the patients' coronary angiograms were reviewed for evidence of plaque disruption. The diagnostic performance of the PDI and angiography were compared. Results Compared to other biomarkers, MPO had the highest specificity (83{\%}) for NSTEMI-A diagnosis (P<0.05). The PDI computed from PAPP-A, MRP8/14 and MPO was higher in NSTEMI-A patients compared to the other three groups (P<0.001) and had the highest diagnostic specificity (87{\%}) with 79{\%} sensitivity and 86{\%} accuracy, which were higher compared to those obtained with MPO, but did not reach statistical significance (P>0.05 for all comparisons). The PDI had higher specificity and accuracy for NSTEMI-A diagnosis compared to coronary angiography (P<0.05). Conclusions A PDI measured within 24 hour of troponin positivity has potential to identify subjects with acute Non-ST-elevation type 1 MI. Additional evidence using other marker combinations and investigation in a sufficiently large non-selected cohort is warranted to establish the diagnostic accuracy of the PDI and its potential role in differentiating type 1 and type 2 MI in patients presenting with troponin elevation of uncertain etiology.",
author = "Al-Mohaissen, {Maha A.} and Carere, {Ronald G.} and Mancini, {G. B.John} and Humphries, {Karin H.} and Whalen, {Beth A.} and Terry Lee and Scheuermeyer, {Frank X.} and Ignaszewski, {Andrew P.}",
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Al-Mohaissen, MA, Carere, RG, Mancini, GBJ, Humphries, KH, Whalen, BA, Lee, T, Scheuermeyer, FX & Ignaszewski, AP 2016, 'A plaque disruption index identifies patients with non-STE-type 1 myocardial infarction within 24 hours of troponin positivity', PLoS ONE, vol. 11, no. 10, e0164315. https://doi.org/10.1371/journal.pone.0164315

A plaque disruption index identifies patients with non-STE-type 1 myocardial infarction within 24 hours of troponin positivity. / Al-Mohaissen, Maha A.; Carere, Ronald G.; Mancini, G. B.John; Humphries, Karin H.; Whalen, Beth A.; Lee, Terry; Scheuermeyer, Frank X.; Ignaszewski, Andrew P.

In: PLoS ONE, Vol. 11, No. 10, e0164315, 01.10.2016.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - A plaque disruption index identifies patients with non-STE-type 1 myocardial infarction within 24 hours of troponin positivity

AU - Al-Mohaissen, Maha A.

AU - Carere, Ronald G.

AU - Mancini, G. B.John

AU - Humphries, Karin H.

AU - Whalen, Beth A.

AU - Lee, Terry

AU - Scheuermeyer, Frank X.

AU - Ignaszewski, Andrew P.

PY - 2016/10/1

Y1 - 2016/10/1

N2 - Background Markers of plaque destabilization and disruption may have a role in identifying non-STEtype 1 Myocardial Infarction in patients presenting with troponin elevation. We hypothesized that a plaque disruption index (PDI) derived from multiple biomarkers and measured within 24 hours from the first detectable troponin in patients with acute non-STE- type 1 MI (NSTEMI-A) will confirm the diagnosis and identify these patients with higher specificity when compared to individual markers and coronary angiography. Methods We examined 4 biomarkers of plaque destabilization and disruption: myeloperoxidase (MPO), high-sensitivity interleukin-6, myeloid-related protein 8/14 (MRP8/14) and pregnancy- associated plasma protein-A (PAPP-A) in 83 consecutive patients in 4 groups: stable non-obstructive coronary artery disease (CAD), stable obstructive CAD, NSTEMI-A (enrolled within 24 hours of troponin positivity), and NSTEMI-L (Late presentation NSTEMI, enrolled beyond the 24 hour limit). The PDI was calculated and the patients' coronary angiograms were reviewed for evidence of plaque disruption. The diagnostic performance of the PDI and angiography were compared. Results Compared to other biomarkers, MPO had the highest specificity (83%) for NSTEMI-A diagnosis (P<0.05). The PDI computed from PAPP-A, MRP8/14 and MPO was higher in NSTEMI-A patients compared to the other three groups (P<0.001) and had the highest diagnostic specificity (87%) with 79% sensitivity and 86% accuracy, which were higher compared to those obtained with MPO, but did not reach statistical significance (P>0.05 for all comparisons). The PDI had higher specificity and accuracy for NSTEMI-A diagnosis compared to coronary angiography (P<0.05). Conclusions A PDI measured within 24 hour of troponin positivity has potential to identify subjects with acute Non-ST-elevation type 1 MI. Additional evidence using other marker combinations and investigation in a sufficiently large non-selected cohort is warranted to establish the diagnostic accuracy of the PDI and its potential role in differentiating type 1 and type 2 MI in patients presenting with troponin elevation of uncertain etiology.

AB - Background Markers of plaque destabilization and disruption may have a role in identifying non-STEtype 1 Myocardial Infarction in patients presenting with troponin elevation. We hypothesized that a plaque disruption index (PDI) derived from multiple biomarkers and measured within 24 hours from the first detectable troponin in patients with acute non-STE- type 1 MI (NSTEMI-A) will confirm the diagnosis and identify these patients with higher specificity when compared to individual markers and coronary angiography. Methods We examined 4 biomarkers of plaque destabilization and disruption: myeloperoxidase (MPO), high-sensitivity interleukin-6, myeloid-related protein 8/14 (MRP8/14) and pregnancy- associated plasma protein-A (PAPP-A) in 83 consecutive patients in 4 groups: stable non-obstructive coronary artery disease (CAD), stable obstructive CAD, NSTEMI-A (enrolled within 24 hours of troponin positivity), and NSTEMI-L (Late presentation NSTEMI, enrolled beyond the 24 hour limit). The PDI was calculated and the patients' coronary angiograms were reviewed for evidence of plaque disruption. The diagnostic performance of the PDI and angiography were compared. Results Compared to other biomarkers, MPO had the highest specificity (83%) for NSTEMI-A diagnosis (P<0.05). The PDI computed from PAPP-A, MRP8/14 and MPO was higher in NSTEMI-A patients compared to the other three groups (P<0.001) and had the highest diagnostic specificity (87%) with 79% sensitivity and 86% accuracy, which were higher compared to those obtained with MPO, but did not reach statistical significance (P>0.05 for all comparisons). The PDI had higher specificity and accuracy for NSTEMI-A diagnosis compared to coronary angiography (P<0.05). Conclusions A PDI measured within 24 hour of troponin positivity has potential to identify subjects with acute Non-ST-elevation type 1 MI. Additional evidence using other marker combinations and investigation in a sufficiently large non-selected cohort is warranted to establish the diagnostic accuracy of the PDI and its potential role in differentiating type 1 and type 2 MI in patients presenting with troponin elevation of uncertain etiology.

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U2 - 10.1371/journal.pone.0164315

DO - 10.1371/journal.pone.0164315

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VL - 11

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