Association of Serum TREM2 with Acute Coronary Syndrome and its Severity: A Cross-sectional Study

Introduction: Acute Coronary Syndrome (ACS) remains a major cause of morbidity and mortality worldwide, primarily driven by plaque rupture and thrombotic occlusion in coronary arteries. Traditional biomarkers provide limited insight into the inflammatory and lipid-driven mechanisms underlying plaque instability. Soluble Triggering Receptor Expressed on Myeloid Cells 2 (sTREM2), a shed form of a membrane-bound receptor expressed on macrophages and other myeloid cells, has been implicated in lipid metabolism, immune regulation and tissue homeostasis. Although its role in neurodegenerative and metabolic disorders has been increasingly recognised, its relevance in atherosclerosis and acute coronary events is still being elucidated. Exploring sTREM2 in this setting may offer novel perspectives on immune-metabolic activity in coronary artery disease. Aim: To investigate the association between serum sTREM2 levels and ACS, as well as disease severity. Materials and Methods: The present observational crosssectional study was conducted at the Department of Biochemistry, SRM Medical College Hospital and Research Centre, Potheri, SRM Nagar, Kattankulathur, Tamil Nadu, India, between December 2023 and August 2024. A total of 180 participants were enrolled, including 90 newly diagnosed ACS patients and 90 age- and gender-matched healthy controls. Inclusion criteria for the ACS group included adults aged over 25 years with a confirmed diagnosis of ACS {STElevation Myocardial Infarction (STEMI), Non ST-Elevation Myocardial Infarction (NSTEMI), or unstable angina} based on clinical presentation, Electrocardiographic (ECG) changes and cardiac biomarkers. Controls were healthy volunteers with no history of cardiovascular disease. Serum sTREM2 levels, lipid profile, Apolipoprotein B (ApoB) and high-sensitivity C-Reactive Protein (hs-CRP) were measured. ACS severity was assessed using the Synergy Between Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery (SYNTAX I) score. Demographic parameters including age, gender, Body Mass Index (BMI). Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 22.0. Data normality was assessed using the Shapiro-Wilk test. Group comparisons were conducted using the Mann-Whitney U test and Kruskal-Wallis test. Spearman’s correlation was used to evaluate relationships between variables and Receiver Operating Characteristic (ROC) curve analysis assessed the diagnostic utility of biomarkers. A p-value