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Clinical criteria replenish high-sensitive troponin and inflammatory markers in the stratification of patients with suspected acute coronary syndrome.

Stähli BE, Yonekawa K, Altwegg LA, Wyss C, Hof D, Fischbacher P, Brauchlin A, Schulthess G, Krayenbühl PA, von Eckardstein A, Hersberger M, Neidhart M, Gay S, Novopashenny I, Wolters R, Frank M, Wischnewsky MB, Lüscher TF, Maier W - PLoS ONE (2014)

Bottom Line: Eleven out of 15 biomarkers were elevated in patients with CE compared to those without.Equivalence testing of AUCs of risk models and non-inferiority testing demonstrated that the clinical TIMI risk score alone was non-inferior to its combination with hs-cTnT in predicting CE.In patients presenting without ST-elevations, identification of those prone to CE is best based on clinical assessment based on TIMI risk score criteria and hs-cTnT.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland.

ABSTRACT

Objectives: In patients with suspected acute coronary syndrome (ACS), rapid triage is essential. The aim of this study was to establish a tool for risk prediction of 30-day cardiac events (CE) on admission. 30-day cardiac events (CE) were defined as early coronary revascularization, subsequent myocardial infarction, or cardiovascular death within 30 days.

Methods and results: This single-centre, prospective cohort study included 377 consecutive patients presenting to the emergency department with suspected ACS and for whom troponin T measurements were requested on clinical grounds. Fifteen biomarkers were analyzed in the admission sample, and clinical parameters were assessed by the TIMI risk score for unstable angina/Non-ST myocardial infarction and the GRACE risk score. Sixty-nine (18%) patients presented with and 308 (82%) without ST-elevations, respectively. Coronary angiography was performed in 165 (44%) patients with subsequent percutaneous coronary intervention--accounting for the majority of CE--in 123 (33%) patients, respectively. Eleven out of 15 biomarkers were elevated in patients with CE compared to those without. High-sensitive troponin T (hs-cTnT) was the best univariate biomarker to predict CE in Non-ST-elevation patients (AUC 0.80), but did not yield incremental information above clinical TIMI risk score (AUC 0.80 vs 0.82, p = 0.69). Equivalence testing of AUCs of risk models and non-inferiority testing demonstrated that the clinical TIMI risk score alone was non-inferior to its combination with hs-cTnT in predicting CE.

Conclusions: In patients presenting without ST-elevations, identification of those prone to CE is best based on clinical assessment based on TIMI risk score criteria and hs-cTnT.

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Related in: MedlinePlus

Study flow chart of the prospective, observational MyRiAD study.Abbreviations: ER, emergency room; CA, coronary angiography; CAD, coronary artery disease; CE, cardiac events (composite of early coronary revascularization by percutaneous coronary intervention [PCI] or coronary artery bypass grafting [CABG], subsequent myocardial infarction or cardiovascular death); c-cTnT, conventional cardiac troponin T; CK, creatine kinase; CK-MB, creatine kinase-myocardial band.
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pone-0098626-g001: Study flow chart of the prospective, observational MyRiAD study.Abbreviations: ER, emergency room; CA, coronary angiography; CAD, coronary artery disease; CE, cardiac events (composite of early coronary revascularization by percutaneous coronary intervention [PCI] or coronary artery bypass grafting [CABG], subsequent myocardial infarction or cardiovascular death); c-cTnT, conventional cardiac troponin T; CK, creatine kinase; CK-MB, creatine kinase-myocardial band.

Mentions: All patients underwent the regular emergency room assessments including detailed clinical history taking, physical examination, 12-lead electrocardiogram (ECG), and the pertinent blood analysis routine (see below). Subsequent clinical management, in particular as to additional examinations (i.e. coronary angiography) and therapies, was based on current practice and left at the discretion of the treating physicians. Routine markers including c-cTnT, myoglobin, creatine kinase (CK), creatine kinase-myocardial band (CK-MB), N-terminal pro-brain natriuretic peptide (NT-proBNP), and D-dimers were available to the treating physicians. There were no study-specific interventions. Details on screening, enrollment, and patient management are summarized in the study flow chart (figure 1).


Clinical criteria replenish high-sensitive troponin and inflammatory markers in the stratification of patients with suspected acute coronary syndrome.

Stähli BE, Yonekawa K, Altwegg LA, Wyss C, Hof D, Fischbacher P, Brauchlin A, Schulthess G, Krayenbühl PA, von Eckardstein A, Hersberger M, Neidhart M, Gay S, Novopashenny I, Wolters R, Frank M, Wischnewsky MB, Lüscher TF, Maier W - PLoS ONE (2014)

Study flow chart of the prospective, observational MyRiAD study.Abbreviations: ER, emergency room; CA, coronary angiography; CAD, coronary artery disease; CE, cardiac events (composite of early coronary revascularization by percutaneous coronary intervention [PCI] or coronary artery bypass grafting [CABG], subsequent myocardial infarction or cardiovascular death); c-cTnT, conventional cardiac troponin T; CK, creatine kinase; CK-MB, creatine kinase-myocardial band.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4043791&req=5

pone-0098626-g001: Study flow chart of the prospective, observational MyRiAD study.Abbreviations: ER, emergency room; CA, coronary angiography; CAD, coronary artery disease; CE, cardiac events (composite of early coronary revascularization by percutaneous coronary intervention [PCI] or coronary artery bypass grafting [CABG], subsequent myocardial infarction or cardiovascular death); c-cTnT, conventional cardiac troponin T; CK, creatine kinase; CK-MB, creatine kinase-myocardial band.
Mentions: All patients underwent the regular emergency room assessments including detailed clinical history taking, physical examination, 12-lead electrocardiogram (ECG), and the pertinent blood analysis routine (see below). Subsequent clinical management, in particular as to additional examinations (i.e. coronary angiography) and therapies, was based on current practice and left at the discretion of the treating physicians. Routine markers including c-cTnT, myoglobin, creatine kinase (CK), creatine kinase-myocardial band (CK-MB), N-terminal pro-brain natriuretic peptide (NT-proBNP), and D-dimers were available to the treating physicians. There were no study-specific interventions. Details on screening, enrollment, and patient management are summarized in the study flow chart (figure 1).

Bottom Line: Eleven out of 15 biomarkers were elevated in patients with CE compared to those without.Equivalence testing of AUCs of risk models and non-inferiority testing demonstrated that the clinical TIMI risk score alone was non-inferior to its combination with hs-cTnT in predicting CE.In patients presenting without ST-elevations, identification of those prone to CE is best based on clinical assessment based on TIMI risk score criteria and hs-cTnT.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland.

ABSTRACT

Objectives: In patients with suspected acute coronary syndrome (ACS), rapid triage is essential. The aim of this study was to establish a tool for risk prediction of 30-day cardiac events (CE) on admission. 30-day cardiac events (CE) were defined as early coronary revascularization, subsequent myocardial infarction, or cardiovascular death within 30 days.

Methods and results: This single-centre, prospective cohort study included 377 consecutive patients presenting to the emergency department with suspected ACS and for whom troponin T measurements were requested on clinical grounds. Fifteen biomarkers were analyzed in the admission sample, and clinical parameters were assessed by the TIMI risk score for unstable angina/Non-ST myocardial infarction and the GRACE risk score. Sixty-nine (18%) patients presented with and 308 (82%) without ST-elevations, respectively. Coronary angiography was performed in 165 (44%) patients with subsequent percutaneous coronary intervention--accounting for the majority of CE--in 123 (33%) patients, respectively. Eleven out of 15 biomarkers were elevated in patients with CE compared to those without. High-sensitive troponin T (hs-cTnT) was the best univariate biomarker to predict CE in Non-ST-elevation patients (AUC 0.80), but did not yield incremental information above clinical TIMI risk score (AUC 0.80 vs 0.82, p = 0.69). Equivalence testing of AUCs of risk models and non-inferiority testing demonstrated that the clinical TIMI risk score alone was non-inferior to its combination with hs-cTnT in predicting CE.

Conclusions: In patients presenting without ST-elevations, identification of those prone to CE is best based on clinical assessment based on TIMI risk score criteria and hs-cTnT.

Show MeSH
Related in: MedlinePlus