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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

Diagnostic performance of high-sensitive cardiac troponin T (hs-cTnT), myeloperoxidase (MPO), myeloid-related protein 8/14 (MRP 8/14), and conventional cardiac troponin T (c-cTnT) in relation to the clinical TIMI risk score of patients with suspected ACS and no obvious ST-segment elevations at presentation (Non-ST-elevation patients).AUC indicates area under the curve. The clinical TIMI risk score is the sum of 6 clinical factors without the biomarker variable of the 7 originally described risk predictors of the TIMI unstable angina/Non-ST myocardial infarction risk score.
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pone-0098626-g002: Diagnostic performance of high-sensitive cardiac troponin T (hs-cTnT), myeloperoxidase (MPO), myeloid-related protein 8/14 (MRP 8/14), and conventional cardiac troponin T (c-cTnT) in relation to the clinical TIMI risk score of patients with suspected ACS and no obvious ST-segment elevations at presentation (Non-ST-elevation patients).AUC indicates area under the curve. The clinical TIMI risk score is the sum of 6 clinical factors without the biomarker variable of the 7 originally described risk predictors of the TIMI unstable angina/Non-ST myocardial infarction risk score.

Mentions: Most remarkably, performance of single biomarkers – notably of hs-cTnT, MPO, MRP 8/14, and c-cTnT – in predicting CE within 30 days, depended on the clinical pretest probability of ACS. Figure 2 illustrates ROC curves of hs-cTnT, MPO, MRP 8/14, and c-cTnT for the prediction of CE within 30 days in patients with low, intermediate, and high clinical TIMI risk scores, respectively. In patients with low (≤2) and intermediate ( = 3) clinical TIMI risk scores, hs-cTnT significantly predicted CE within 30 days (p<0.001 and p = 0.005), while it did not add to risk prediction in patients with high (>3) clinical TIMI risk scores (p = 0.35). To the contrary, MPO accurately predicted CE within 30 days in patients with high (>3) clinical TIMI risk scores (p = 0.006), while ROC-analyses were not significant in patients with low (≤2) and intermediate ( = 3) clinical TIMI risk scores (p = 0.23 and p = 0.35, respectively). ROC-analyses revealed no significant AUC curves for MRP 8/14 independent of the clinical TIMI risk group, and only significant values for low (≤2) clinical TIMI risk scores for c-cTnT (p = 0.013).


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)

Diagnostic performance of high-sensitive cardiac troponin T (hs-cTnT), myeloperoxidase (MPO), myeloid-related protein 8/14 (MRP 8/14), and conventional cardiac troponin T (c-cTnT) in relation to the clinical TIMI risk score of patients with suspected ACS and no obvious ST-segment elevations at presentation (Non-ST-elevation patients).AUC indicates area under the curve. The clinical TIMI risk score is the sum of 6 clinical factors without the biomarker variable of the 7 originally described risk predictors of the TIMI unstable angina/Non-ST myocardial infarction risk score.
© Copyright Policy
Related In: Results  -  Collection

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

pone-0098626-g002: Diagnostic performance of high-sensitive cardiac troponin T (hs-cTnT), myeloperoxidase (MPO), myeloid-related protein 8/14 (MRP 8/14), and conventional cardiac troponin T (c-cTnT) in relation to the clinical TIMI risk score of patients with suspected ACS and no obvious ST-segment elevations at presentation (Non-ST-elevation patients).AUC indicates area under the curve. The clinical TIMI risk score is the sum of 6 clinical factors without the biomarker variable of the 7 originally described risk predictors of the TIMI unstable angina/Non-ST myocardial infarction risk score.
Mentions: Most remarkably, performance of single biomarkers – notably of hs-cTnT, MPO, MRP 8/14, and c-cTnT – in predicting CE within 30 days, depended on the clinical pretest probability of ACS. Figure 2 illustrates ROC curves of hs-cTnT, MPO, MRP 8/14, and c-cTnT for the prediction of CE within 30 days in patients with low, intermediate, and high clinical TIMI risk scores, respectively. In patients with low (≤2) and intermediate ( = 3) clinical TIMI risk scores, hs-cTnT significantly predicted CE within 30 days (p<0.001 and p = 0.005), while it did not add to risk prediction in patients with high (>3) clinical TIMI risk scores (p = 0.35). To the contrary, MPO accurately predicted CE within 30 days in patients with high (>3) clinical TIMI risk scores (p = 0.006), while ROC-analyses were not significant in patients with low (≤2) and intermediate ( = 3) clinical TIMI risk scores (p = 0.23 and p = 0.35, respectively). ROC-analyses revealed no significant AUC curves for MRP 8/14 independent of the clinical TIMI risk group, and only significant values for low (≤2) clinical TIMI risk scores for c-cTnT (p = 0.013).

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