The Value of Serum YKL-40 and TNF-α in the Diagnosis of Acute ST-Segment Elevation Myocardial Infarction

Abstract

Background. Acute ST-segment elevation myocardial infarction (STEMI) is a serious cardiovascular disease that poses a great threat to the life and health of patients. Therefore, early diagnosis is important for STEMI patient treatment and prognosis. The purpose of this study was to investigate the value of serum YKL-40 and TNF-α in the diagnosis of STEMI. Methods. From October 2020 to February 2022, 120 patients with STEMI were admitted to the Chest Pain Center of the Second People’s Hospital of Hefei, and 81 patients with negative coronary angiography were selected as the control group. Serum YKL-40 and TNF-α concentrations were measured by sandwich ELISA. Pearson correlation was used to analyze the correlation between serum YKL-40, TNF-α, and serum troponin I (cTnI) in STEMI patients; multivariate logistic regression analysis was used to screen independent risk factors for STEMI. Three diagnostic models were constructed: cTnI univariate model (model A), combined serum YKL-40 and TNF-α model other than cTnI (model B), and combined cTnI and serum YKL-40 and TNF-α model (model C). We assessed the clinical usefulness of the diagnostic model by comparing AUC with decision curve analysis (DCA). Results. Serum YKL-40 and TNF-α in the STEMI group were significantly higher than those in the control group ( P < 0.001 ). On Pearson correlation analysis, there was a significant positive correlation between serum YKL-40, TNF-α, and cTnI levels in STEMI patients. Multivariate logistic regression analysis showed that serum YKL-40 and TNF-α were independent risk factors for the development of STEMI. The results of ROC analysis showed that the area under the curve (AUC) of serum YKL-40 for predicting the occurrence of STEMI was 0.704. The AUC of serum TNF-α for predicting the occurrence of STEMI was 0.852. The AUC of cTnI as a traditional model, model A, for predicting the occurrence of STEMI was 0.875. Model B predicted STEMI with an AUC of 0.851. The addition of serum YKL-40 and serum TNF-α to the traditional diagnostic model composed of cTnI constituted a new diagnostic model; that is, the AUC of model C for predicting the occurrence of STEMI was 0.930. Model C had a better net benefit between a threshold probability of 70–95% for DCA. Conclusion. In this study, we demonstrate the utility of serum YKL-40 and TNF-α as diagnostic markers for STEMI and the clinical utility of diagnostic models by combining serum YKL-40 and TNF-α with cTnI.

Establishment and validation of a clinical nomogram model based on serum YKL-40 to predict major adverse cardiovascular events during hospitalization in patients with acute ST-segment elevation myocardial infarction

“…By RF and multivariate logistic regression analysis, our study identified serum YKL-40 as an independent risk factor for MACE during hospitalization after PCI in STEMI patients, a result consistent with previous studies ( 16 ). Consistent with the existing cardiovascular disease literature ( 10 , 14–16 ), we found that STEMI patients with higher serum YKL-40 levels tended to be older, male, diabetic, family history of coronary heart disease, anterior myocardial infarction, had a higher proportion of multivessel disease, and greater Gensini score. All these features suggest that elevated serum YKL-40 levels may influence the prognosis of STEMI.…”

“…To date, serum YKL-40 has been implicated as a novel inflammatory marker contributing to cell proliferation and differentiation, angiogenesis, and tissue remodeling ( 8 ). It has been shown that serum YKL-40 is closely associated with the early and late stages of the atherosclerotic process, and YKL-40 induces monocytes to mature into macrophages, which are then secreted by macrophages and activated macrophages at a later stage of differentiation ( 9 ).In addition, previous studies have shown that YKL-40 levels are higher in patients with myocardial infarction ( 10 ), stable coronary artery disease ( 11 , 12 ), and heart failure ( 13 ). High levels of serum YKL-40 are an independent predictor of MACE after PCI in STEMI patients, and serum YKL-40 can be used as a biomarker to predict the long-term prognosis of STEMI patients after PCI ( 14 , 15 ).…”

An Evaluation of Plasma TNF, VEGF-A, and IL-6 Determination as a Risk Marker of Atherosclerotic Vascular Damage in Early-Onset CAD Patients

“…Other authors have reported different TNF plasma concentrations. The range is from a few [ 33 ] to several tens of pg/mL [ 34 ] in CAD patients, while in healthy people, it is about 2 pg/mL [ 35 ]. Our patients were all treated with statins, which reduce plasma TNF levels [ 36 ].…”

A plasma proteomic approach in patients with heart failure after acute myocardial infarction: insights into the pathogenesis and progression of the disease

“…These had all been previously shown to be enhanced in AMI patients ( 31 ). The AUC of the serum levels of TNF-α for predicting the occurrence of acute ST-elevated MI was 0.852 ( 32 ), and a TNF-α inhibitor was able to reduce the infarct area ( 33 ).…”