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The role of cardiac biomarkers in the diagnosis and management of patients presenting with suspected acute coronary syndrome.

Christenson E, Christenson RH - Ann Lab Med (2013)

Bottom Line: As assays for cTn have been evolved that are capable of reliably detecting smaller and smaller quantities in the blood, a dilemma has emerged as to how to use this new information.Several studies have attempted to answer this question and have shown that these lower concentrations of cTn have important prognostic significance and, more importantly, that intervention in these patients leads to improved clinical outcomes.New algorithms incorporating BNP, NT-proBNP, and more sensitive cTn assays hold promise for more rapid diagnosis or rule-out of MI, allowing for appropriate management steps to be initiated and more efficient and effective utilization of healthcare resources.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Johns Hopkins Hospital, Baltimore, USA.

ABSTRACT
Myocardial infarction (MI) is the leading cause of death in the developed world. Biomarkers have an essential role in diagnosis, risk stratification, guiding management and clinical decision making in the setting of patients presenting with signs and symptoms of MI. Cardiac troponin (cTn) rose to prominence during the 1990s and has evolved to be the cornerstone for diagnosis of MI. The current criteria for MI diagnosis include a rise and/or fall in cTn with at least one value above the 99th percentile of the upper reference limit. Along with cTn, the natriuretic peptides B-type natriuretic peptide (BNP) and amino-terminal proBNP (NT-proBNP) have an important role in determining prognosis and guiding management. As assays for cTn have been evolved that are capable of reliably detecting smaller and smaller quantities in the blood, a dilemma has emerged as to how to use this new information. Several studies have attempted to answer this question and have shown that these lower concentrations of cTn have important prognostic significance and, more importantly, that intervention in these patients leads to improved clinical outcomes. New algorithms incorporating BNP, NT-proBNP, and more sensitive cTn assays hold promise for more rapid diagnosis or rule-out of MI, allowing for appropriate management steps to be initiated and more efficient and effective utilization of healthcare resources.

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Related in: MedlinePlus

Definition of myocardial infarction. Adapted with permission from J Am Coll Cardiol 2012;60:1581-8.
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Figure 2: Definition of myocardial infarction. Adapted with permission from J Am Coll Cardiol 2012;60:1581-8.

Mentions: Fig. 2 displays the universal definition of MI which states that the term should be used when there is evidence of myocardial necrosis in a clinical setting consistent with acute myocardial ischemia [3]. With the appropriate clinical and diagnostic picture, detection of a rising and/or falling pattern of cTn with at least one value above the 99th percentile of a reference control population meets the criteria for MI.


The role of cardiac biomarkers in the diagnosis and management of patients presenting with suspected acute coronary syndrome.

Christenson E, Christenson RH - Ann Lab Med (2013)

Definition of myocardial infarction. Adapted with permission from J Am Coll Cardiol 2012;60:1581-8.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3756234&req=5

Figure 2: Definition of myocardial infarction. Adapted with permission from J Am Coll Cardiol 2012;60:1581-8.
Mentions: Fig. 2 displays the universal definition of MI which states that the term should be used when there is evidence of myocardial necrosis in a clinical setting consistent with acute myocardial ischemia [3]. With the appropriate clinical and diagnostic picture, detection of a rising and/or falling pattern of cTn with at least one value above the 99th percentile of a reference control population meets the criteria for MI.

Bottom Line: As assays for cTn have been evolved that are capable of reliably detecting smaller and smaller quantities in the blood, a dilemma has emerged as to how to use this new information.Several studies have attempted to answer this question and have shown that these lower concentrations of cTn have important prognostic significance and, more importantly, that intervention in these patients leads to improved clinical outcomes.New algorithms incorporating BNP, NT-proBNP, and more sensitive cTn assays hold promise for more rapid diagnosis or rule-out of MI, allowing for appropriate management steps to be initiated and more efficient and effective utilization of healthcare resources.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Johns Hopkins Hospital, Baltimore, USA.

ABSTRACT
Myocardial infarction (MI) is the leading cause of death in the developed world. Biomarkers have an essential role in diagnosis, risk stratification, guiding management and clinical decision making in the setting of patients presenting with signs and symptoms of MI. Cardiac troponin (cTn) rose to prominence during the 1990s and has evolved to be the cornerstone for diagnosis of MI. The current criteria for MI diagnosis include a rise and/or fall in cTn with at least one value above the 99th percentile of the upper reference limit. Along with cTn, the natriuretic peptides B-type natriuretic peptide (BNP) and amino-terminal proBNP (NT-proBNP) have an important role in determining prognosis and guiding management. As assays for cTn have been evolved that are capable of reliably detecting smaller and smaller quantities in the blood, a dilemma has emerged as to how to use this new information. Several studies have attempted to answer this question and have shown that these lower concentrations of cTn have important prognostic significance and, more importantly, that intervention in these patients leads to improved clinical outcomes. New algorithms incorporating BNP, NT-proBNP, and more sensitive cTn assays hold promise for more rapid diagnosis or rule-out of MI, allowing for appropriate management steps to be initiated and more efficient and effective utilization of healthcare resources.

Show MeSH
Related in: MedlinePlus