Comparison of pentraxin-3 and ischemia-modified albumin with troponin in early diagnosis of acute coronary syndrome

Prognostic Value of Pentraxin-3 Change After Primary Percutaneous Coronary Intervention in Patients with ST-Segment Elevation Myocardial Infarction

Purpose

So far, ST-segment elevation myocardial infarction (STEMI) is still the main cause of morbidity and mortality of cardiovascular diseases worldwide. Recent studies showed that pentraxin-3 (PTX3) was related to the early diagnosis and prognosis of coronary heart disease. This study aimed to investigate the dynamical change of PTX3 after primary percutaneous coronary intervention (pPCI) in STEMI patients and its prognostic value.

Patients and methods

In this prospective cohort study, a total of 350 patients were enrolled. The plasma level of PTX3 was measured at admission, 24-hour and 5-day after pPCI. The primary endpoint was the incidence of major adverse cardiac cerebral events (MACCEs) during 1-year follow-up.

Results

Compared with the admission, PTX3 levels were significantly increased at 24 hours, and decreased at 5 days after pPCI in the whole cohort. PTX3 levels at these three time points were not significantly different between the patients with and without MACCEs. Notably, the change in PTX3 from admission to post-pPCI 24-hour (ΔPTX3) was higher in patients with MACCEs (112.83 vs 17.94 ng/dl, P = 0.001). The ROC curves showed that the cut-off value was 29.22 ng/dl and the area under curves was 0.622 (95% CI: 0.554-0.690, p = 0.001). Multivariable cox regression models revealed that the high ΔPTX3 group was an independent predictor of MACCEs (adjusted HR = 2.010, 95% CI = 1.280-3.186, p = 0.003). The higher ΔPTX3 group had significantly higher incidences of revascularization (HR = 2.094, 95% CI: 1.056-4.150, p = 0.034) and composite MACCEs (HR = 2.219, 95% CI: 1.425-3.454, p < 0.001). However, the change of PTX3 level from admission to post-pPCI 5-day had no independently predictive value.

Conclusion

The higher increase of PTX3 level 24-hour after pPCI appeared to have a potential value in independently predicting the incidence of 1-year MACCEs in STEMI patients, especially for coronary revascularization.

Serum Concentrations of Ischaemia-Modified Albumin in Acute Coronary Syndrome: A Systematic Review and Meta-Analysis

The identification of novel circulating biomarkers of acute coronary syndrome (ACS) may improve diagnosis and management. We conducted a systematic review and meta-analysis of ischaemia-modified albumin (IMA), an emerging biomarker of ischaemia and oxidative stress, in ACS. We searched PubMed, Web of Science, and Scopus from inception to March 2022, and assessed the risk of bias and certainty of evidence with the Joanna Briggs Institute Critical Appraisal Checklist and GRADE, respectively. In 18 studies (1654 ACS patients and 1023 healthy controls), IMA concentrations were significantly higher in ACS (standard mean difference, SMD = 2.38, 95% CI 1.88 to 2.88; p < 0.001; low certainty of evidence). The effect size was not associated with pre-defined study or patient characteristics, barring the country where the study was conducted. There were no significant differences in effect size between acute myocardial infarction (MI) and unstable angina (UA), and between ST-elevation (STEMI) and non-ST-elevation MI (NSTEMI). However, the effect size was progressively larger in UA (SMD = 1.63), NSTEMI (SMD = 1.91), and STEMI (3.26). Our meta-analysis suggests that IMA might be useful to diagnose ACS. Further studies are warranted to compare the diagnostic performance of IMA vs. established markers, e.g., troponin, and to determine its potential utility in discriminating between UA, NSTEMI, and STEMI (PROSPERO registration number: CRD42021324603).

Utility of Elevated Pentraxin-3 Level as Inflammatory Marker for Predicting Adverse Outcomes in Patients With Acute Coronary Syndrome: A Meta-Analysis

Background

Vascular inflammation plays an important role in the pathogenesis and development of acute coronary syndrome (ACS). However, studies on the association between elevated pentraxin-3 level and adverse outcomes in patients with ACS have yielded controversial results. The purpose of this meta-analysis was to assess the value of elevated pentraxin-3 level as an inflammatory marker for predicting adverse outcomes in patients with ACS.

Methods

Two authors systematically searched the articles indexed in PubMed, Embase, CNKI, Wanfang, and VIP databases up to March 31, 2021. Studies reporting the association of elevated pentraxin-3 level at the acute phase with cardiovascular mortality, all-cause mortality, or cardiac events (cardiac death, non-fatal myocardial infarction, revascularization, or heart failure) in patients with ACS were included.

Results

A total of 8,775 ACS patients from 12 studies were identified and analyzed. When compared the lowest pentraxin-3 level, ACS patients with the highest pentraxin-3 level conferred an increased risk of cardiovascular mortality [risk ratio (RR) 2.10; 95% CI 1.44–3.06], all-cause mortality (RR 1.99; 95% CI 1.46–2.71), and cardiac events (RR 1.74; 95% CI 1.32–2.29), even after adjustment for some important confounders. Subgroup analysis indicated that the association of elevated pentraxin-3 level with cardiac events appeared to be stronger in ST-segment elevation myocardial infarction patients (RR 2.72; 95% CI 1.69–4.36) than in all patients with ACS (RR 1.59; 95% CI 1.10–2.29).

Conclusions

Elevated pentraxin-3 level is possibly an independent predictor of adverse outcomes in patients with ACS. Assessment of pentraxin-3 level at the acute phase can provide important information for early risk stratification of ACS.

Association between serum lipoprotein-associated phospholipase A2, ischemic modified albumin and acute coronary syndrome: a cross-sectional study

Lipoprotein-associated phospholipase A2 (Lp-PLA2) is a newly emerging biomarker with strong pro-inflammatory effects, and is an independent risk predictor of atherosclerotic plaque rupture and thrombosis. In addition, ischemic modified albumin (IMA) is another important marker for the evaluation of myocardial ischemia, and has been approved by the U.S. Food and Drug Administration. The objective of this study was to investigate serum Lp-PLA2 and IMA in the early diagnosis, progression and prognosis of acute coronary syndrome (ACS). Serum Lp-PLA2 and IMA were detected using an AU5800 automatic biochemical analyzer in samples from 180 patients with ACS [n = 60 with unstable angina pectoris (UA), n = 56 with non-ST segment elevation myocardial infarction (NSTEMI), and n = 64 with ST segment elevation myocardial infarction (STEMI)] and 60 healthy control subjects. The relationship between Lp-PLA2 and IMA with Gensini score and the number of coronary artery lesions was explored, and logistic regression was conducted to identify risk factors for major adverse cardiovascular events (MACE). Serum Lp-PLA2 and IMA were significantly higher in all ACS subgroups compared to the control group (P < 0.05), were positively associated with the severity of ACS based on the Gensini score (P < 0.05), and were significantly higher in patients with double- and triple-vessel lesions compared to those with single-vessel lesions and healthy controls (P < 0.05). Logistic regression identified Lp-PLA2, IMA, and troponin I levels as independent risk factors for MACE. Lp-PLA2 and IMA were predictive of the degree of myocardial ischemia in patients with ACS, and may provide important clinical significance for the early diagnosis of ACS and the choice of treatment strategy.