Systemic Biomarkers in Predicting Clinical Outcomes among Patients with Non-ST Segment Elevation Myocardial Infarction: A Systematic Review
Jovita Echere *
The University of Texas Health Science Center at Houston School of Public Health, USA.
George Sayegh
Ross University School of Medicine, USA.
Felix Asaju
Delta State University College of Health Sciences, Nigeria.
Eke Nwanne Okafor
Sumy State University Medical Institute, Ukraine.
Oluwaseun Abayomi Oguntuase
Caribbean Medical University, Curaçao.
Armelle Jordan Leukeu
Xavier University School of Medicine, Aruba.
Elijah Oluwasegun Ayoigbala Adetunji
Kharkiv National Medical University, Ukraine.
Omar Badr
Alexandria University Faculty of Medicine, Egypt.
Stephanie M. Brown
Queens University College of Medicine, Barbados.
Shaheen Sultana
Siddhartha Medical College (SMC), India.
Regina Azipu
University of Calabar College of Medical Sciences, Nigeria.
Onyinye Ezewudo
College of Medicine, University of Nigeria, Nigeria.
Marian Obi
Madonna University College of Medicine, Nigeria.
Frederick Ferguson
Summa Health, USA.
Shwetha Gopal
Bassett Medical Center, USA.
*Author to whom correspondence should be addressed.
Abstract
Background: The ability to predict clinical outcomes in Non-ST Segment Elevation Myocardial Infarction (NSTEMI) could potentially lead to better risk stratification and treatment management. This systematic review aims to evaluate the predictive value of systemic biomarkers on the clinical outcomes among NSTEMI patients.
Methods: A comprehensive search across PubMed, Web of Science and Scopus was conducted, adhering to PRISMA Statement 2020 guidelines. Original clinical studies involving NSTEMI patients with measured systemic biomarkers were considered. Keyword combinations included the following: 'NSTEMI', 'systemic biomarkers', 'clinical outcomes', 'major adverse cardiac events', and/or 'mortality.
Results: We included 7 studies in total pooling in 863 participants, with biomarkers such as Syntax score, Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), Matrix Metallopeptidase 9 (MMP-9), and Perforin (P), among others. All systemic inflammation (SI) biomarkers were found significantly elevated in patients with high Syntax scores. ROC values for major adverse cardiac events (MACE) ranged from 0.592 to 0.637, and for overall mortality from 0.524 to 0.761. Monocytic MMP-9 mRNA levels were found increased in patients with NSTEMI (0.9 +/- 0.3 relative units (RU)). Positive correlations were found between cardiac troponin I plasma concentrations and the frequency of Perforin-positive cells during the first week after the NSTEMI.
Conclusion: Systemic biomarkers, including Syntax score, NLR, PLR, MMP-9, and Perforin, show potential predictive value for clinical outcomes in NSTEMI patients. Their use could aid in early risk stratification and management. However, more large-scale, multicenter studies are warranted to validate these findings.
Keywords: Systemic biomarkers, Non-ST segment elevation myocardial infarction, predictive value, risk stratification, syntax score, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio