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Observational Study
. 2026 Jan 1:578:120510.
doi: 10.1016/j.cca.2025.120510. Epub 2025 Jul 25.

Diagnostic and prognostic utility of endocan in suspected myocardial infarction: an international cohort study

Franja Dugar  1 , Pedro Lopez-Ayala  1 , Luca Koechlin  2 , Paolo Bima  1 , Jonas Glaeser  1 , Carlos Spagnuolo  1 , Luca Crisanti  3 , Clara Wick  1 , Karin Wildi  1 , Emel Kaplan  1 , Ivo Strebel  1 , Oscar Miro  4 , Francisco Javier Martin-Sanchez  4 , Michael Christ  5 , Beata Morawiec  6 , Maria Rubini Gimenez  1 , Thomas Nestelberger  1 , Jasper Boeddinghaus  3 , Christian Mueller  7 ; APACE investigators
Collaborators, Affiliations
Observational Study

Diagnostic and prognostic utility of endocan in suspected myocardial infarction: an international cohort study

Franja Dugar et al. Clin Chim Acta. .

Abstract

Background: The possible clinical utility of endocan, a novel inflammatory biomarker involved in the initiation and progression of atherosclerosis, is largely unknown. We aimed to evaluate its diagnostic and prognostic performance in chest pain patients presenting to the emergency department (ED).

Methods: We prospectively enrolled patients presenting with suspected myocardial infarction (MI) to the ED in an international multicenter study. Endocan, high-sensitivity C-reactive protein (hs-CRP), and high-sensitivity cardiac troponin T (hs-cTnT) were measured in blood samples obtained at presentation. Final diagnoses were centrally adjudicated by two independent cardiologists applying the 4th universal definition of MI and current guidelines. Non-ST-elevation MI (NSTEMI) was the diagnostic endpoint and 5-year cardiovascular death was the primary prognostic endpoint.

Results: Among 4728 patients, 843 (17.8 %) had NSTEMI. The diagnostic discrimination of endocan for NSTEMI was low (area under the curve (AUC) 0.585 [95 % CI: 0.563-0.607]. Its combination with hs-cTnT (0.939 [95 % CI: 0.931-0.947]) did not improve the discriminative performance of hs-cTnT alone (0.937 [95 % CI: 0.930-0.950]). Long-term prognostic accuracy of endocan was higher versus hs-CRP, but lower versus hs-cTnT (AUC 0.730 [0.710-0.760] vs 0.650 [0.620-0.680] vs 0.810 [0.790-0.830], respectively). Endocan was associated with an increased 5-year risk for cardiovascular mortality. However, it did not provide relevant incremental prognostic value when added on top of a base model that included SCORE2 risk factors and hs-cTnT.

Conclusion: Endocan has a low diagnostic accuracy for NSTEMI, and moderate long-term prognostic accuracy for cardiovascular death.

Clinical trial registration: ClinicalTrials.gov number, NCT00470587, https://clinicaltrials.gov/ct2/show/NCT00470587https://clinicaltrials.gov/ct2/show/NCT00470587.

Keywords: Endocan; Inflammatory biomarkers; Myocardial infarction; Troponin.

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Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: PLA has received research grants from the Swiss Heart Foundation (FF20079 and FF21103) and speaker’s honoraria from Quidel and Roche, paid to the institution and outside the submitted work. LK has received a research grant from the Swiss Heart Foundation, University of Basel, the Swiss Academy of Medical Sciences and the Gottfried and Julia Bangerter-Rhyner Foundation, the “Freiwillige Akademische Gesellschaft Basel”, as well as speaker honoraria from Roche Diagnostics, Abbott, Polymedco, Dr Risch and Siemens, paid to the institution and outside the submitted work. KW has received research support from the University of Queensland (PhD scholarship), the Wesley Medical Research Foundation, University of Basel and Swiss National Science Foundation, outside the submitted work. TN has received research support from the Swiss National Science Foundation (P400PM_191037/1), the Prof. Dr. Max Cloëtta Foundation, the Margarete und Walter Lichtenstein-Stiftung (3MS1038), and the University of Basel, the University Hospital Basel as well as speaker/consulting honoraria or research support from Edwards Lifesciences, Pronova Medical, Meril, Boston Scientific, Medtronic, Abbott, Beckman Coulter, Bayer, Ortho Clinical Diagnostics and Orion Pharma, outside the submitted work. JB is supported by an Edinburgh Doctoral College Scholarship and received research grants from the University of Basel, the University Hospital of Basel, the Division of Internal Medicine, the Swiss Academy of Medical Sciences, the Gottfried and Julia Bangerter-Rhyner Foundation, the Swiss National Science Foundation, and the “Freie Akademische Gesellschaft Basel”, and honoraria from Siemens Healthineers, Roche Diagnostics, Ortho Clinical Diagnostics, Quidel Corporation, and Beckman Coulter, and travel support from Medtronic and Cordis, all outside the submitted work. CM reports receiving research support from the Swiss National Science Foundation, the Swiss Heart Foundation, the KTI, the Stiftung für kardiovaskuläre Forschung Basel, the University of Basel; Abbott, Beckman Coulter, Brahms, Idorsia, LSI Medience Corporation, Novartis, Ortho Diagnostics, Quidel, Roche, Siemens, Singulex, Sphingotec, outside the submitted work, as well as speaker honoraria/consulting honoraria from Amgen, Astra Zeneca, Bayer, Boehringer Ingelheim, BMS, Idorsia, Novartis, Osler, Roche, and Sanofi, all paid to the institution. All other authors declare no competing interests.

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