Nature Cardiovascular Research (2024 )Cite this article
Myocardial infarction is a leading cause of death globally but is notoriously difficult to predict. We aimed to identify biomarkers of an imminent first myocardial infarction and design relevant prediction models. Here, we constructed a new case–cohort consortium of 2,018 persons without prior cardiovascular disease from six European cohorts, among whom 420 developed a first myocardial infarction within 6 months after the baseline blood draw. We analyzed 817 proteins and 1,025 metabolites in biobanked blood and 16 clinical variables. Forty-eight proteins, 43 metabolites, age, sex and systolic blood pressure were associated with the risk of an imminent first myocardial infarction. Brain natriuretic peptide was most consistently associated with the risk of imminent myocardial infarction. Using clinically readily available variables, we devised a prediction model for an imminent first myocardial infarction for clinical use in the general population, with good discriminatory performance and potential for motivating primary prevention efforts.
Despite declining age-standardized rates, myocardial infarction remains the leading and increasing cause of death globally1. Prevention of myocardial infarction is highly prioritized2, but the targeting of primary preventive efforts is hampered by inefficient means of identifying individuals at the highest risk for an imminent myocardial infarction (IMI). This could be partially explained by the inability of most risk prediction models to account for the highly dynamic nature of the period leading up to a myocardial infarction. For instance, traumatic events, such as a cancer diagnosis or loss of a spouse, markedly increase the risk of myocardial infarction3,4. In addition, the degree of stenosis in the culprit lesion in the coronary artery appears to increase in the months just before the myocardial infarction5. Nonetheless, to date, most biomarkers have been investigated over several years of follow-up because of a low number of individuals with a first myocardial infarction shortly after baseline in the general population. Hence, a large population-based study focusing on identifying biomarkers of an IMI is needed.