title: Multimarker approach for the prediction of microvascular obstruction after acute ST-segment elevation myocardial infarction: a prospective, observational study.
abstract: Presence of microvascular obstruction (MVO) derived from cardiac magnetic resonance (CMR) imaging is among the strongest outcome predictors after ST-segment elevation myocardial infarction (STEMI). We aimed to investigate the comparative predictive values of different biomarkers for the occurrence of MVO in a large cohort of reperfused STEMI patients.
  
  
  
  This study included 128 STEMI patients. CMR imaging was performed within the first week after infarction to assess infarct characteristics, including MVO. Admission and peak concentrations of high-sensitivity cardiac troponin T (hs-cTnT), creatine kinase (CK), N-terminal pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity C-reactive protein (hs-CRP), lactate dehydrogenase (LDH), aspartate transaminase (AST) and alanine transaminase (ALT) were measured.
  
  
  
  MVO was detected in 69 patients (54%). hs-cTnT, CK, hs-CRP, LDH, AST and ALT peak concentrations showed similar prognostic value for the prediction of MVO (area under the curve (AUC) = 0.77, 0.77, 0.68, 0.79, 0.78 and 0.73, all p > 0.05), whereas the prognostic utility of NT-proBNP was weakly lower (AUC = 0.64, p < 0.05). Combination of these biomarkers did not increase predictive utility compared to hs-cTnT alone (p = 0.349).
  
  
  
  hs-cTnT, CK, hs-CRP, LDH, AST and ALT peak concentrations provided similar prognostic value for the prediction of MVO. The prognostic utility of NT-proBNP was lower. Combining these biomarkers could not further improve predictive utility compared to hs-cTnT alone.
authors.affiliation: University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria.
authors.forename: Hans-Josef
authors.initials: HJ
authors.lastname: Feistritzer
authors.affiliation: University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria.
authors.forename: Sebastian Johannes
authors.initials: SJ
authors.lastname: Reinstadler
authors.affiliation: University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria.
authors.forename: Gert
authors.initials: G
authors.lastname: Klug
authors.affiliation: University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria.
authors.forename: Martin
authors.initials: M
authors.lastname: Reindl
authors.affiliation: University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Wöhrer
authors.affiliation: University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria.
authors.forename: Christoph
authors.initials: C
authors.lastname: Brenner
authors.affiliation: Department of Radiology, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria.
authors.forename: Agnes
authors.initials: A
authors.lastname: Mayr
authors.affiliation: University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria.
authors.forename: Johannes
authors.initials: J
authors.lastname: Mair
authors.affiliation: University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria. Bernhard.Metzler@tirol-kliniken.at.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Metzler
mesh_terms: D015415:Biomarkers / Q000097:blood*; D002097:C-Reactive Protein / Q000378:metabolism; D003326:Coronary Circulation; D054059:Coronary Occlusion / Q000097:blood* / Q000175:diagnosis / Q000209:etiology; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D003402:Creatine Kinase / Q000097:blood; D005500:Follow-Up Studies; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008833:Microcirculation / Q000502:physiology*; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D062645:Percutaneous Coronary Intervention; D011446:Prospective Studies; D000072657:ST Elevation Myocardial Infarction / Q000097:blood / Q000150:complications* / Q000601:surgery; D013997:Time Factors; D020107:Troponin T / Q000097:blood
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; D020107:Troponin T; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D002097:C-Reactive Protein; D003402:Creatine Kinase
keywords: Biomarker; Cardiovascular magnetic resonance imaging; Myocardial infarction