Abstract
Background: The potential utility of microRNAs (miRNAs) in the diagnosis, prognosis, and treatment of multiple disease states has been an area of great interest since their discovery. In patients with cardiovascular disease, there is a large pool of literature amassed from the last decade assessing their diagnostic and prognostic potential. This systematic review sought to determine whether existing literature supports the use of miRNAs as prognostic markers after an Acute Coronary Syndrome (ACS) presentation. Methods: A systematic review of published articles from 2005–2019 using MEDLINE and EMBASE databases was undertaken independently by two reviewers. Studies addressing prognosis in an ACS population yielded 32 studies and 2 systematic reviews. Results/conclusion: 23 prospective studies reported significant differences in miRNA levels and 16 compared the predictive power of miRNAs. The most common miRNAs assessed included miR-133a, -208b, -21, -1, -34a, -150, and -423, shown to be involved in cell differentiation, apoptosis, and angiogenesis. Barriers to the use of miRNAs as prognostic markers include bias in miRNA selection, small sample size, variable normalization of data, and adjustment for confounders. Therefore, findings from this systematic review do not support the use of miRNAs for prognostication post-ACS beyond traditional cardiovascular risk factors, existing risk scores, and stratifications tools.
Highlights
Coronary artery disease (CAD) is the leading cause of mortality worldwide [1]
As noncoding RNAs regulate posttranscription gene expression, the potential of miRNAs as a biomarker or as a mediator of the disease process has been identified [2]. This has yielded a multitude of studies in miRNA level characterisation and its various potential applications including diagnosis [3] and prognosis [4,5,6] in CAD
A comprehensive search of the accessible published literature was conducted by combining key search terms using the Boolean term AND and search term variations of microRNAs, coronary artery disease/cardiovascular disease, and outcomes including morbidity/mortality using the Boolean term OR as keywords to maximize sensitivity with the last search taking place on 27 August 2019
Summary
Coronary artery disease (CAD) is the leading cause of mortality worldwide [1]. Advancements in early diagnosis and prognostication would allow for better risk stratification in an aging global population. Since the discovery of miRNAs, there has been great interest in their role in various disease processes, including atherosclerosis. As noncoding RNAs regulate posttranscription gene expression, the potential of miRNAs as a biomarker or as a mediator of the disease process has been identified [2]. This has yielded a multitude of studies in miRNA level characterisation and its various potential applications including diagnosis [3] and prognosis [4,5,6] in CAD. This systematic review sought to determine whether existing literature supports the use of miRNAs as prognostic markers after an Acute Coronary Syndrome (ACS). The most common miRNAs assessed included miR-133a, -208b, -21, -1, -34a,
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