• Y Devaux, M Mueller, P Haaf, E Goretti, R Twerenbold, J Zangrando, M Vausort, T Reichlin, K Wildi, B Moehring, D R Wagner, and C Mueller.
• Laboratory of Cardiovascular Research, Centre de Recherche Public de la Santé, Luxembourg, Luxembourg.
• J. Intern. Med. 2015 Feb 1;277(2):260-71.

ObjectivesTo address the diagnostic value of circulating microRNAs (miRNAs) in patients presenting with acute chest pain.DesignIn a prospective, international, multicentre study, six miRNAs (miR-133a, miR-208b, miR-223, miR-320a, miR-451 and miR-499) were simultaneously measured in a blinded fashion in 1155 unselected patients presenting with acute chest pain to the emergency department. The final diagnosis was adjudicated by two independent cardiologists. The clinical follow-up period was 2 years.ResultsAcute myocardial infarction (AMI) was the adjudicated final diagnosis in 224 patients (19%). Levels of miR-208b, miR-499 and miR-320a were significantly higher in patients with AMI compared to those with other final diagnoses. MiR-208b provided the highest diagnostic accuracy for AMI (area under the receiver operating characteristic curve 0.76, 95% confidence interval 0.72-0.80). This diagnostic value was lower than that of the fourth-generation cardiac troponin T (cTnT; 0.84) or the high-sensitivity cTnT (hs-cTnT; 0.94; both P < 0.001 for comparison). None of the six miRNAs provided added diagnostic value when combined with cTnT or hs-cTnT (ns for the comparison of combinations vs. cTnT or hs-cTnT alone). During follow-up, 102 (9%) patients died. Levels of MiR-208b were higher in patients who died within 30 days, but the prognostic accuracy was low to moderate. None of the miRNAs predicted long-term mortality.ConclusionThe miRNAs investigated in this study do not seem to provide incremental diagnostic or prognostic value in patients presenting with suspected AMI.© 2013 The Association for the Publication of the Journal of Internal Medicine.

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