Predictive value of circulating cardiomyocyte-specific cell-free DNA levels for heart failure risk after acute ST-segment elevation myocardial infarction

Introduction
The onset of heart failure (HF) often signifies disease progression and unfavorable prognoses in cases of acute ST-segment elevation myocardial infarction (STEMI).

Aim
To explore the potential value of circulating cardiomyocyte-specific cell-free DNA (CS cfDNA) levels as an indicator for predicting risk of HF after acute STEMI.

Material and methods
Overall, 146 STEMI patients were included and classified into two groups according to CS cfDNA levels at admission: Group N1: ≤ 164 copies/ml, Group N2: > 164 copies/ml. A follow-up period of approximately 355 days was completed.

Results
The prevalence of HF in Group N2 was significantly higher than that in Group N1 (77.4% vs. 18.3%, p < 0.001). ROC curve analysis revealed an AUC of 0.838 (95% CI: 0.688–0.899) for CS cfDNA in predicting onset of HF after STEMI. This AUC value was notably elevated in comparison to that of conventional biomarkers, namely NT-proBNP (AUC = 0.726) and soluble suppression of tumorigenicity-2 (sST2) (AUC = 0.635). Cox proportional hazards regression model analysis further confirmed that level of CS cfDNA at the time of admission was an independent predictor of HF following STEMI, with a hazard ratio (HR) of 2.804 and a 95% CI of 1.086–7.243, achieving statistical significance at p = 0.035.

Conclusions
There was a significant positive association between CS cfDNA levels and cardiac injury biomarkers (such as cTnI and sST2). CS cfDNA levels may represent a promising and important biomarker for predicting the occurrence of HF after STEMI, providing novel strategies for clinical management and prognostic evaluation of patients.