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Letter Circulating microRNA-221 and 222 for the Severity of Coronary Artery Disease in Acute Coronary Syndrome

Dear Editor, We read the recent article entitled “Associations of Circulating microRNA-221 and 222 With the Severity of Coronary Artery Lesions in Acute Coronary Syndrome Patients” by Yu et al. with great interest. They demonstrated that the circulating levels of microRNA-221 and 222 (miR-221/222) in patients with acute coronary syndrome (ACS) were elevated and positively associated with the severity of the coronary artery disease (CAD) assessed by the Gensini score. They concluded that circulating miR-221/222 may be novel biomarkers for coronary artery stenosis ≥ 50% and the occurrence of ACS. The synergy between percutaneous coronary intervention with taxus and cardiac surgery (SYNTAX) and SYNTAX II scores were designed to improve decision making between the percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG), by allowing for a long-term individualized risk assessment of patients with the severe complex coronary artery disease. However, Yu et al. did not calculate the SYNTAX and SYNTAX II scores for the severity of CAD in their study population. They also divided the ACS group (n = 267) into the unstable angina pectoris (UA) group (n = 191) and acute myocardial infarction (AMI) group (n = 76). However, there is no detailed information for the patients with ST-elevation myocardial infarction (STEMI) and non–STelevation myocardial infarction (NSTEMI) in the ACS group. Recent studies pointed out that many easily available inflammatory and oxidative biomarkers together with demographic and clinical parameters including platelet-tolymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), monocyte-to–high-density lipoprotein cholesterol (MHR), C-reactive protein (CRP)–to-albumin ratio (CAR), serum total bilirubin, resting heart rate, and the CHA2DS2VASc (congestive heart failure, hypertension, age ≥ 75 (doubled), diabetes mellitus, prior stroke or transient ischemic attack (doubled), vascular disease, age 65–74 , female) scores were shown to be independent risk factors and novel prognostic markers for cardiovascular (CV) events, in-hospital mortality as well as the extent, severity and complexity of CAD. Yu et al. do not provide information regarding easily available hematological, biochemical, demographic, and clinical parameters such as PLR, NLR, MHR, CAR, bilirubin, resting heart rate, and CHA2DS2-VASc score. Their multivariate logistic regression analysis lacks these robust and reliable parameters; this may affect their study findings. In conclusion, we suggest that the combination of several inflammatory biomarkers, relating scores as well as demographic and clinical parameters, could provide better prediction of the extent, severity and complexity of CAD.