Circulating exosomal miR-20b-5p and miR-1273g-3p were potential biomarkers for diagnosis and prognosis of acute coronary syndrome

Sep 30, 2026

Circulating exosomal miR-20b-5p and miR-1273g-3p are evaluated for diagnostic and prognostic utility in acute coronary syndrome (ACS). A retrospective study enrolled 138 ACS patients and 129 controls with normal coronary arteries between Oct 2020 and Nov 2023. Exosomes were isolated from plasma and miRNA expression quantified by RT-qPCR, while major adverse cardiovascular events (MACEs) after PCI were tracked for 1 year. Both miRNAs were elevated in ACS; ROC analysis showed diagnostic discrimination with combined testing improving AUCs. Elevated miR-20b-5p predicted higher MACE incidence, with multivariable Cox regression confirming its independent prognostic association.

LanguageEnglish

CategoryHealthcare

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Introduction

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Results

Conclusions

Key findings

What is known and what is new?

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Circulating exosomal miR-20b-5p and miR-1273g-3p were potential biomarkers for diagnosis and prognosis of acute coronary syndrome Ruiqiang Weng1,2,3, Xia Li1, Junli Zhao1, Xiaodong Gu1,2,3, Sudong Liu1,2,3 1Meizhou Clinical College, Shantou University Medical College, Meizhou, China; 2Institute of Basic Medical Sciences, Meizhou People’s Hospital, Meizhou, China; 3Guangdong Provincial Engineering and Technological Research Center for Molecular Diagnostics of Cardiovascular Diseases, Meizhou, China Contributions: (I) Conception and design: S Liu, R Weng; (II) Administrative support: S Liu; (III) Provision of study materials or patients: R Weng, X Li, J Zhao; (IV) Collection and assembly of data: X Li, J Zhao; (V) Data analysis and interpretation: R Weng, X Gu; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Sudong Liu, PhD. Meizhou Clinical College, Shantou University Medical College, No. 63 Xinfeng Road, Meijiang District, Meizhou 514031, China; Institute of Basic Medical Sciences, Meizhou People’s Hospital, Meizhou, China; Guangdong Provincial Engineering and Technological Research Center for Molecular Diagnostics of Cardiovascular Diseases, Meizhou, [China. Email: vanguard_1987@163.com](China. Email: vanguard_1987@163.com). Background: Acute coronary syndrome (ACS) remains one of the leading causes of mortality worldwide. This study investigates the diagnostic and prognostic value of circulating exosomal miR-20b-5p and miR- 1273g-3p in ACS. Methods: This retrospective study randomly included 138 patients diagnosed with ACS according to the 2020 European Society of Cardiology (ESC) Guidelines for managing ACSs and 129 controls with normal coronary arteries (NCA) between October 2020 and November 2023 in Meizhou People’s Hospital. Plasmaderived exosomes were isolated from patients with ACS and NCA controls. The expression of miR-20b- 5p and miR-1273g-3p was measured using reverse transcription-quantitative polymerase chain reaction (RT-qPCR) . Major adverse cardiovascular events (MACEs) within 1 year after percutaneous coronary intervention (PCI) were recorded. Receiver operating characteristic (ROC) curve analysis was carried out to assess diagnostic performance, and Kaplan-Meier survival analysis with Cox regression was applied to examine association of exosomal miR-20b-5p with MACEs. Results: Both exosomal miR-20b-5p and miR-1273g-3p were markedly elevated in patients compared with NCA controls. The ROC analysis yielded an area under the curve (AUC) of 0.705 [95% confidence interval (CI): 0.639–0.771] for miR-20b-5p and 0.720 (95% CI: 0.657–0.783) for miR-1273g-3p, both slightly lower than that of cardiac troponin I (cTnI) (AUC =0.761; 95% CI: 0.693–0.829) . Combined detection of cTnI with miR-20b-5p and miR-1273g-3p achieved AUCs of 0.818 (95% CI: 0.764–0.871) and 0.794 (95% CI: 0.737–0.850), respectively. During follow-up, patients with elevated miR-20b-5p levels exhibited a significantly higher incidence of MACEs. Multivariable Cox regression confirmed an independent association between miR-20b-5p expression and MACEs, with a hazard ratio of 3.107 (95% CI: 1.157–8.340, P=0.02) . Conclusions: Exosomal miR-20b-5p and miR-1273g-3p represent potential diagnostic biomarkers for ACS, and miR-20b-5p also provides prognostic value for predicting MACEs. Keywords: Exosome; miR-20b-5p; miR-1273g-3p; acute coronary syndrome (ACS) Submitted Jul 03, 2025. Accepted for publication Oct 17, 2025. Published online Dec 24, 2025. doi: 10.21037/cdt-2025-368 View this article at: [https://dx.doi.org/10.21037/cdt-2025-368](https://dx.doi.org/10.21037/cdt-2025-368) © AME Publishing Company. Cardiovasc Diagn Ther 2025;15(6):1149-1160 | [https://dx.doi.org/10.21037/cdt-2025-368](https://dx.doi.org/10.21037/cdt-2025-368) 1150 Introduction Acute coronary syndrome (ACS) is a fatal clinical condition caused by acute myocardial ischemia, primarily resul

FAQs

What is the main purpose of the study?

To assess whether circulating exosomal miR-20b-5p and miR-1273g-3p can serve as diagnostic biomarkers for ACS and whether miR-20b-5p also predicts prognosis via MACEs after PCI.

How were miRNA levels measured and what comparison was used?

Plasma-derived exosomes were isolated, and miR-20b-5p and miR-1273g-3p expression was measured using RT-qPCR. ACS patients were compared with controls who had normal coronary arteries.

What diagnostic performance did the study report?

ROC analysis showed AUCs of 0.705 for miR-20b-5p and 0.720 for miR-1273g-3p, and combination detection with cTnI produced higher AUCs (0.818 for miR-20b-5p with cTnI; 0.794 for miR-1273g-3p with cTnI).

How did exosomal miR-20b-5p relate to long-term outcomes?

During follow-up, patients with elevated miR-20b-5p had a significantly higher incidence of MACEs, and multivariable Cox regression indicated an independent association with a hazard ratio of 3.107 (P=0.02).

Sep 30, 2026

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