Circulating biomarkers associated with pyroptosis in the differential diagnosis of ST-segment elevation and non-ST-segment elevation myocardial infarction

Objectives To evaluate the biomarker value of NOD-, LRR-, and pyrin domain-containing protein 3 (NLRP3), gasdermin D (GSDMD), caspase-1, interleukin 1β (IL-1β), and IL-18 in the systemic circulation in ST-elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) as a possible new biomarker candidate, and to compare their sensitivity and specificity to well-defined and built in biomarkers in acute myocardial infarction (AMI), including high sensitive-cardiac troponin I (hs-cTnI) and N-terminal proBNP (NT-proBNP) in patients with STEMI or NSTEMI. Methods The study included 149 patients with acute STEMI, 151 patients with NSTEMI, and 151 healthy volunteers in the check-up outpatient clinic, admitted to Sisli Hamidiye Etfal Education and Research Hospital, Emergency Department, Istanbul. Results CK-MB, hs-cTnI, pro-BNP, NLRP3, GSDMD, caspase-1, IL-1β, and IL-18 levels were higher in the STEMI group compared to the other groups, whereas these parameters were lower in the control group compared to the NSTEMI groups. hs-cTnI, CK-MB, caspase-1, IL-1β, and IL-18 showed high sensitivity and specificity, suggesting their potential as reliable diagnostic markers in STEMI patients. Conclusions NLRP3 inflammasome may play a role in the production of pro-inflammatory cytokines such as IL-1β and IL-18 in STEMI. Inflammasome-related biomarkers show potential as adjunctive tools for distinguishing between STEMI and NSTEMI; however, further studies with multiple timepoints and larger sample sizes are needed to confirm their diagnostic utility and clinical applicability.