A biomarker-based scoring system for identifying myocardial infarction types: MINOCA vs. MICAD

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Abstract Background Around 10% of patients with myocardial infarction presents with nonobstructive coronary arteries (MINOCA), differing significantly from those with obstructive coronary lesions (MICAD). Inflammation plays a role in myocardial infarction and inflammatory biomarkers have emerged as valuable tools in cardiovascular research. Purpose This study aims to develop a biomarker-based index for accurate and efficient differentiation between MINOCA and MICAD. Methods This prospective, observational cohort study included 111 consecutive myocardial infarction patients admitted to our hospital between 2021 and 2023. After coronary angiography we classified patients into two groups according to the ESC definitions: 46 MINOCA and 65 MICAD. Blood samples were collected within 24 hours of symptom onset to measure hs-CRP, IL-6, ADMA, and peak hs-T troponin. Associations between each biomarker and MICAD risk were analyzed using logistic regression models: (1) unadjusted and (2) adjusted for age and sex (OR < 1: higher likelihood of MINOCA; OR > 1: greater likelihood of MICAD). Biomarker-specific scores were developed to assess discriminatory ability, optimized using a genetic algorithm to maximize AUC. Finally, a combined biomarker-based score was constructed. Results The study included 111 patients with a mean age of 67 years (SD 13.3), 68.5% of whom were male. MINOCA patients had significantly lower peak high-sensitivity troponin T levels compared to MICAD patients (259.1 ng/L vs. 2032.3 ng/L, p < 0.001) and a higher proportion with normal left ventricular ejection fraction (LVEF >55%; 67.4% vs. 41.5%, p = 0.007). IL-6 and hs-TnT were associated with an increased risk of MICAD (OR 1.58, 95% CI 1.01–2.46, p = 0.045; OR 2.27, 95% CI 1.61–3.21, p = 0.001, respectively). Using the genetic optimization algorithm, the scoring system described in Table 1 was developed. Each point increase in the score multiplied the MICAD risk by 6, with an AUC of 0.918. Example probabilities for men and women aged 50, 65, and 80 are shown in Figure 1. Conclusions We developed a risk score for identifying myocardial infarction types, based on inflammatory biomarkers and hsTnT. This biomarker-based scoring system provides superior discriminatory power for distinguishing between myocardial infarction types compared to the individual analysis of each biomarker.Table 1:Biomarker-based scoreFigure 1.Probability of MICAD

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