Speaker
Description
Abstract
Background: Cardiac biomarkers are widely accepted as diagnostic indicators for myocardial infarction. Their prognostic value has also been approved in the short to medium term outcomes of myocardial infarction. However, their utility in assessing long-term prognosis remains unclear in acute myocardial infarction (AMI).
Methods: Utilizing the MIMIC-III database, the study included 1,186 AMI patients. It constructed a dynamic model to measure myocardial necrosis biomarkers, focusing on the kinetics of cardiac troponin T (cTnT) and creatine kinase-MB (CKMB). The model's parameters were evaluated for their ability to predict 10-year mortality, and the study analyzed how different levels of kidney function measured by glomerular filtration rate (GFR) affected the benefits of diuretic therapy.
Results: The study identified 'krecovery' as a key metric for myocardial injury, effective in stratifying 10-year mortality risk. Combined with kidney function, these biomarkers predict outcomes. Diuretics showed minimal benefit in moderate injury with normal kidney function but potential long-term benefits in severe injury with poor kidney function. GFR could substitute for 'kel_cTnT,' a biomarker reflecting cTnT clearance. Diuretic benefits were limited in moderate injury with normal kidney function (HR = 4.29, 95% CI = 1.92-9.57, p < 0.001) and promising in severe injury with poor kidney function (HR = 0.61, 95% CI = 0.41-0.90, p < 0.5).
Conclusions: The dynamic biomarker model developed in this study offers significant advancement in assessing the long-term prognosis of AMI patients. It demonstrates that personalized treatment, particularly with diuretics, can be informed by the degree of myocardial injury and kidney function. The findings challenge existing guidelines by suggesting that diuretics may benefit certain patients with impaired kidney function. The stuZdy concludes that integrating these digital biomarkers into clinical practice could enhance the accuracy and comprehensiveness of AMI prognostic scoring systems, supporting personalized and precision medicine approaches.