Abstract
Importance: S100A12 is a calcium binding protein which is involved in inflammation and progression of atherosclerosis.Objective: We sought to investigate the utility of S100A12 as a biomarker for the early diagnosis and prognostication of patients presenting with ST-segment elevation myocardial infarction (STEMI).Design, Setting, and Participants: S100A12 was measured in 1023 patients presenting to the emergency department with acute chest pain between June 2012 and November 2015. An independent cohort of 398 patients enrolled at 3 different hospitals served as a validation cohort.Main Outcomes and Measures: The primary clinical endpoint of interest was major adverse cardiac and cerebral events (MACCE) defined as a composite of all-cause death, MI, stroke, or hospitalization for heart failure.Results: A total of 438/1023 patients (42.8%) in the diagnosis cohort were adjudicated as STEMI, among whom plasma S100A12 levels increased within 30 min and peaked 1–2 h after symptom onset. Compared with high-sensitivity cardiac troponin T and creatine kinase-MB isoenzyme, S100A12 more accurately identified STEMI, especially within the first 2 h after symptom onset (area under the curve 0.963 compared with 0.860 for hscTnT and 0.711 for CK-MB, both P < 0.05). These results were consistent in the 243-patient validation cohort. The 1-year rate of MACCE was greatest in patients in the highest peak S100A12 tertile, intermediate in the middle tertile and least in the lowest tertile (9.3 vs. 5.7 vs. 3.0% respectively, Ptrend = 0.0006). By multivariable analysis the peak plasma concentration of S100A12 was an independent predictor of MACCE within 1 year after STEMI (HR, 1.001, 95%CI, 1.000–1.002; P = 0.0104).Conclusions and Relevance: S100A12 rapidly identified patients with STEMI, more accurately than other cardiac biomarkers, especially within the first 2 h after symptom onset. The peak plasma S100A12 level was a strong predictor of 1-year prognosis after STEMI.
Highlights
Acute myocardial infarction (AMI) is a major worldwide cause of morbidity and mortality [1]
Diagnosis of segment elevation myocardial infarction (STEMI) is dependent on early elevation of cardiac biomarkers, most commonly high-sensitivity cardiac troponin T or creatine kinase MB isoenzyme (CK-MB), in concert with consistent symptoms and an abnormal electrocardiogram (ECG)
Among the first cohort of 1,023 consecutive patients presenting with acute chest pain, 438 (42.8%) were adjudicated as STEMI
Summary
Acute myocardial infarction (AMI) is a major worldwide cause of morbidity and mortality [1]. Recognition and intervention in patients with AMI, especially those with ST-segment elevation myocardial infarction (STEMI), is crucial to salvage myocardium and improve long-term prognosis. Diagnosis of STEMI is dependent on early elevation of cardiac biomarkers, most commonly high-sensitivity cardiac troponin T (hscTnT) or creatine kinase MB isoenzyme (CK-MB), in concert with consistent symptoms and an abnormal electrocardiogram (ECG). Patients often present with a non-diagnostic ECG or atypical symptoms [2]. In such patients the rapid diagnosis of STEMI (within 2–3 h of symptom onset, the time period in which rapid reperfusion is most beneficial), can be challenging given a delay in rise of biomarkers
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