title: Diagnostic and prognostic value of circulating microRNAs in patients with acute chest pain.
abstract: OBJECTIVE
  To address the diagnostic value of circulating microRNAs (miRNAs) in patients presenting with acute chest pain.
  
  
  METHODS
  In a prospective, international, multicentre study, six miRNAs (miR-133a, miR-208b, miR-223, miR-320a, miR-451 and miR-499) were simultaneously measured in a blinded fashion in 1155 unselected patients presenting with acute chest pain to the emergency department. The final diagnosis was adjudicated by two independent cardiologists. The clinical follow-up period was 2 years.
  
  
  RESULTS
  Acute myocardial infarction (AMI) was the adjudicated final diagnosis in 224 patients (19%). Levels of miR-208b, miR-499 and miR-320a were significantly higher in patients with AMI compared to those with other final diagnoses. MiR-208b provided the highest diagnostic accuracy for AMI (area under the receiver operating characteristic curve 0.76, 95% confidence interval 0.72-0.80). This diagnostic value was lower than that of the fourth-generation cardiac troponin T (cTnT; 0.84) or the high-sensitivity cTnT (hs-cTnT; 0.94; both P < 0.001 for comparison). None of the six miRNAs provided added diagnostic value when combined with cTnT or hs-cTnT (ns for the comparison of combinations vs. cTnT or hs-cTnT alone). During follow-up, 102 (9%) patients died. Levels of MiR-208b were higher in patients who died within 30 days, but the prognostic accuracy was low to moderate. None of the miRNAs predicted long-term mortality.
  
  
  CONCLUSIONS
  The miRNAs investigated in this study do not seem to provide incremental diagnostic or prognostic value in patients presenting with suspected AMI.
authors.affiliation: Laboratory of Cardiovascular Research, Centre de Recherche Public de la Santé, Luxembourg, Luxembourg.
authors.forename: Y
authors.initials: Y
authors.lastname: Devaux
authors.affiliation: Department of Cardiology, University Hospital Basel, Basel, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Mueller
authors.affiliation: Department of Cardiology, University Hospital Basel, Basel, Switzerland.
authors.forename: P
authors.initials: P
authors.lastname: Haaf
authors.affiliation: Laboratory of Cardiovascular Research, Centre de Recherche Public de la Santé, Luxembourg, Luxembourg.
authors.forename: E
authors.initials: E
authors.lastname: Goretti
authors.affiliation: Department of Cardiology, University Hospital Basel, Basel, Switzerland.
authors.forename: R
authors.initials: R
authors.lastname: Twerenbold
authors.affiliation: Laboratory of Cardiovascular Research, Centre de Recherche Public de la Santé, Luxembourg, Luxembourg.
authors.forename: J
authors.initials: J
authors.lastname: Zangrando
authors.affiliation: Laboratory of Cardiovascular Research, Centre de Recherche Public de la Santé, Luxembourg, Luxembourg.
authors.forename: M
authors.initials: M
authors.lastname: Vausort
authors.affiliation: Department of Cardiology, University Hospital Basel, Basel, Switzerland.
authors.forename: T
authors.initials: T
authors.lastname: Reichlin
authors.affiliation: Department of Cardiology, University Hospital Basel, Basel, Switzerland.
authors.forename: K
authors.initials: K
authors.lastname: Wildi
authors.affiliation: Department of Cardiology, University Hospital Basel, Basel, Switzerland.
authors.forename: B
authors.initials: B
authors.lastname: Moehring
authors.affiliation: Laboratory of Cardiovascular Research, Centre de Recherche Public de la Santé, Luxembourg, Luxembourg.|Department of Cardiology, Centre Hospitalier, Luxembourg, Luxembourg, for The GREAT network.
authors.forename: D R
authors.initials: DR
authors.lastname: Wagner
authors.affiliation: Department of Cardiology, University Hospital Basel, Basel, Switzerland.
authors.forename: C
authors.initials: C
authors.lastname: Mueller
mesh_terms: D000208:Acute Disease; D000368:Aged; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D002637:Chest Pain / Q000209:etiology*; D003937:Diagnosis, Differential; D042241:Early Diagnosis; D004562:Electrocardiography; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008189:Luxembourg; D008297:Male; D035683:MicroRNAs / Q000097:blood*; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013557:Switzerland; D020107:Troponin T / Q000097:blood*
chemical_list: D015415:Biomarkers; D035683:MicroRNAs; D020107:Troponin T
keywords: acute myocardial infarction; biomarker; chest pain; diagnosis; microRNAs; prognosis