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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

Multivariate classification tree analysis of clinical and multiple biomarker information and the resulting algorithm for the identification of those at risk of cardiac events (CE) within 30 days among patients presenting with suspected ACS and no apparent ST-segment elevations (Non-ST-elevation patients).No significant classification with regard to 30-day CE was possible using the clinical GRACE risk score (Bonferroni-adjusted p-value = 0.368).
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pone-0098626-g004: Multivariate classification tree analysis of clinical and multiple biomarker information and the resulting algorithm for the identification of those at risk of cardiac events (CE) within 30 days among patients presenting with suspected ACS and no apparent ST-segment elevations (Non-ST-elevation patients).No significant classification with regard to 30-day CE was possible using the clinical GRACE risk score (Bonferroni-adjusted p-value = 0.368).

Mentions: In Non-ST-elevation patients, multivariate decision tree analysis incorporating clinical data and information of all 15 biomarkers identified a model primarily based on clinical TIMI risk score complemented by serum values of hs-cTnT as most predictive for CE within 30 days (classification accuracy = 85.1%; figure 3). Age, gender, and renal function did not affect classification tree analyses. Using best cutoff-points for the clinical GRACE risk score, no significant classification with regard to CE at 30 days was possible in classification tree analysis (p = 0.37; figure 4).


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)

Multivariate classification tree analysis of clinical and multiple biomarker information and the resulting algorithm for the identification of those at risk of cardiac events (CE) within 30 days among patients presenting with suspected ACS and no apparent ST-segment elevations (Non-ST-elevation patients).No significant classification with regard to 30-day CE was possible using the clinical GRACE risk score (Bonferroni-adjusted p-value = 0.368).
© Copyright Policy
Related In: Results  -  Collection

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

pone-0098626-g004: Multivariate classification tree analysis of clinical and multiple biomarker information and the resulting algorithm for the identification of those at risk of cardiac events (CE) within 30 days among patients presenting with suspected ACS and no apparent ST-segment elevations (Non-ST-elevation patients).No significant classification with regard to 30-day CE was possible using the clinical GRACE risk score (Bonferroni-adjusted p-value = 0.368).
Mentions: In Non-ST-elevation patients, multivariate decision tree analysis incorporating clinical data and information of all 15 biomarkers identified a model primarily based on clinical TIMI risk score complemented by serum values of hs-cTnT as most predictive for CE within 30 days (classification accuracy = 85.1%; figure 3). Age, gender, and renal function did not affect classification tree analyses. Using best cutoff-points for the clinical GRACE risk score, no significant classification with regard to CE at 30 days was possible in classification tree analysis (p = 0.37; figure 4).

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