Elevated serum miR-133a predicts patients at risk of periprocedural myocardial injury after elective percutaneous coronary intervention

Abstract

Background: Periprocedural myocardial injury (PMI) is a frequent complication of percutaneous coronary intervention (PCI) associated with poor prognosis. However, no effective method has been found to identify patients at risk of PMI before the procedure. MicroRNA-133a (miR-133a) has been reported as a novel biomarker in various cardiovascular diseases. Herein, it was sought to determine whether circulating miR-133a could predict PMI before the procedure.

Methods: Eighty patients with negative preoperative values of cardiac troponin T (cTnT) receiving elective PCI for stable coronary artery disease (CAD) were recruited. Venous serum samples were collected on admission and within 16-24 hours post-PCI for miRNA measurements. PMI was defined as a cTnT value above the 99% upper reference limit after the procedure. The association between miR-133a and PMI was further assessed.

Results: Periprocedural myocardial injury occurred in 48 patients. The circulating level of miR-133a was significantly higher in patients with PMI before and after the procedure (both p < 0.001). Receiver operating characteristic curve analysis of the preoperative miR-133a level revealed an area under the curve of 0.891, with a sensitivity of 93.8% and a specificity of 71.9% to predict PMI. Additionally, a decrease was found in fibroblast growth factor receptor 1 (FGFR1) in parallel with an increase in miR-133a levels in patients with PMI.

Conclusions: This study demonstrates for the first time that serum miR-133a can be used as a novel biomarker for early identification of stable CAD patients at risk of PMI undergoing elective PCI. The miR-133a-FGFR1 axis may be involved in the pathogenesis of PMI.

Keywords: microRNA-133a; percutaneous coronary intervention; periprocedural myocardial injury.

Figure 1

Periprocedural serum levels of miR-133a and cardiac troponin T (cTnT); A, B. Distribution of serum levels of miR-133a and cTnT in patients with or without periprocedural myocardial injury (PMI). Median and interquartile range of each category are shown in blue lines. Dotted line represents the 99% upper reference limit of cTnT; C, D. Comparison of miR-133a and cTnT levels. MiR-133a was substantially elevated in patients with PMI both before and after the procedure; *p < 0.001.

Figure 2

Receiver operating characteristic curve for the prediction of periprocedural myocardial injury (PMI). The dotted diagonal line is the Null Hypothesis with area under the curve (AUC) = 0.500. MiR-133a (2^−ΔCT > 0.04427) had a sensitivity of 93.8% and specificity of 71.9% to predict PMI with AUC = 0.891 (95% confidence interval 0.818–0.965).

Figure 3

Serum level of fibroblast growth factor receptor 1 (FGFR1). Circulating levels of FGFR1. FGFR1 was significantly down-regulated in patients with periprocedural myocardial injury (PMI) both before and after the procedure; *p < 0.05; **p < 0.01.