Symptomatic Young Adults with ST-Segment Elevation-Acute Coronary Syndrome or Myocarditis: The Three-Factor Diagnostic Model

Abstract

Myocarditis may mimic myocardial infarction (MI) due to a similar clinical presentation, including chest pain, electrocardiography changes, and laboratory findings. The purpose of the study was to investigate the diagnostic value of clinical, laboratory, and electrocardiography characteristics of patients with acute coronary syndrome - like myocarditis and MI. We analysed 90 patients (≤45 years old) with an initial diagnosis of ST-segment elevation myocardial infarction; 40 patients (44.4%), through the use of cardiac magnetic resonance, were confirmed to have myocarditis, and 50 patients (55.6%) were diagnosed with MI. Patients with myocarditis were younger and had fewer cardiovascular risk factors than those with MI. The cutoff value distinguishing between myocarditis and MI was defined as the age of 36 years. The history of recent infections (82.5% vs. 6%) and C-reactive protein (CRP) levels on admission (Me 45.9 vs. 3.4) was more associated with myocarditis. Further, the QTc interval was inversely correlated with the echocardiographic ejection fraction in both groups but was significantly longer in patients with MI. Non-invasive diagnostics based on clinical features and laboratory findings are basic but still essential tools for differentiation between MI and myocarditis. The three-factor model including the criteria of age, abnormal CRP, and history of recent infections might become a valuable clinical indication.

Keywords: ST-elevation myocardial infarction; myocarditis; young adults.

Figure 1

Study flow chart, MI—Myocardial infarction.

Figure 2

TnT patterns for myocarditis and myocardial infarction including TnT levels on admission and after 24 h.

Figure 3

ROC curve of the age for the diagnosis of acute myocarditis. The AUC was 0.875 (standard error = 0.041, 95% confidence interval: 0.795–0.954). It shows that the sensitivity (90%) and specificity (77.5%) of the age is adequate in statistics.

Figure 4

Three-dimensional charts showing the distribution of variables based on age, CRP level on admission, and history of recent infection: (a) Myocarditis; (b) Myocardial infarction.

Figure 5

Multiparametric model including abnormal CRP level on admission > 5 mg/L, history of recent infection, and age < 36 years; all three are divided into groups presented as number of patients (%).

Figure 6

ROC curve of the QTc on admission for the ejection fraction measured during the first 48 h since admission. The AUC was 0.735 (standard error = 0.055, 95% confidence interval: 0.627–0.844).