Circulating Microvesicles Enriched in miR–126–5p and miR–223–3p: Potential Biomarkers in Acute Coronary Syndrome

<b>Background.</b> The molecular mechanisms underlying acute coronary syndrome (ACS) have been extensively investigated, with a particular focus on the role of circulating microvesicles (MVs) as carriers of regulatory elements that influence hemodynamic changes and coronary flow. Endothelial and platelet dysfunction during ACS alters MV composition, impacting clinical outcomes. This study explores the levels of miR-126-5p and miR-223-3p in circulating MVs and their association with the Thrombolysis in Myocardial Infarction (TIMI) coronary flow classification scale, proposing their potential as biomarkers. <b>Methods.</b> Bioinformatic tools identified miRNAs linked to ACS. Plasma MVs were isolated from ACS patients and healthy controls through high-speed centrifugation. miRNA levels were quantified using quantitative reverse transcription polymerase chain reaction (qRT-PCR) and compared across TIMI 0 and TIMI 3 groups. Diagnostic efficacy was assessed via receiver operating characteristic (ROC) curve analysis. <b>Results.</b> The bioinformatic analysis identified miR-126 and miR-223 present in ACS. miR-126-5p and miR-223-3p were significantly reduced in MVs from TIMI 0 patients compared to TIMI 3. ROC analysis showed high diagnostic accuracy for miR-126-5p (AUC = 0.918; 95% CI: 0.818-1.00; <i>p</i> = 0.001) and miR-223-3p (AUC = 1.00; 95% CI: 1.00-1.00; <i>p</i> < 0.001). <b>Conclusions.</b> Reduced levels of miR-126-5p and miR-223-3p in circulating MVs are strongly associated with impaired coronary flow, positioning these miRNAs as potential biomarkers for ACS risk stratification and therapeutic targeting.