Early assessment of acute coronary syndromes in the emergency department: the potential diagnostic value of circulating microRNAs

Authors

  • Martinus I. F. J. Oerlemans,

    1. Department of Cardiology, University Medical Center Utrecht, The Netherlands
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  • Arend Mosterd,

    1. Department of Cardiology, University Medical Center Utrecht, The Netherlands
    2. Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands
    3. Department of Cardiology, Meander Medical Center, Amersfoort, The Netherlands
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  • Marieke S. Dekker,

    1. Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands
    2. Department of Cardiology, Meander Medical Center, Amersfoort, The Netherlands
    3. Department of Cardiology, Isala Clinics, Zwolle, The Netherlands
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  • Evelyn A. de Vrey,

    1. Department of Cardiology, Meander Medical Center, Amersfoort, The Netherlands
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  • Alain van Mil,

    1. Department of Cardiology, University Medical Center Utrecht, The Netherlands
    2. Interuniversity Cardiology Institute Netherlands (ICIN), Utrecht, The Netherlands
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  • Gerard Pasterkamp,

    1. Department of Cardiology, University Medical Center Utrecht, The Netherlands
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  • Pieter A. Doevendans,

    1. Department of Cardiology, University Medical Center Utrecht, The Netherlands
    2. Interuniversity Cardiology Institute Netherlands (ICIN), Utrecht, The Netherlands
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  • Arno W. Hoes,

    1. Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands
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  • Joost P. G. Sluijter

    Corresponding author
    1. Department of Cardiology, University Medical Center Utrecht, The Netherlands
    2. Interuniversity Cardiology Institute Netherlands (ICIN), Utrecht, The Netherlands
    • Tel: +31 88 755 7155; Fax: +31 30 252 2693

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Abstract

Previous studies investigating the role of circulating microRNAs in acute coronary syndrome (ACS) were based on small patient numbers, performed no comparison with established markers of cardiac injury and did not have appropriate controls. We determined the potential diagnostic value of circulating microRNAs as novel early biomarkers in 332 suspected ACS patients on presentation to the emergency department (ED) in a prospective single-centre study including cardiac miRNAs (miR-1, -208a and -499), miR-21 and miR-146a. Levels of all miRs studied were significantly increased in 106 patients diagnosed with ACS, even in patients with initially negative high-sensitive (hs) troponin or symptom onset <3 h. MiR-1, miR-499 and miR-21 significantly increased the diagnostic value in all suspected ACS patients when added to hs-troponin T (AUC 0.90). These three miRs were strong predictors of ACS independent of clinical co-variates including patient history and cardiovascular risk factors. Interestingly, the combination of these three miRs resulted in a significantly higher AUC of 0.94 than hs-troponin T (0.89). Circulating microRNAs hold great potential as novel early biomarkers for the management of suspected ACS patients.

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