scholarly journals Potential value for new diagnostic markers in the early recognition of acute coronary syndromes

CJEM ◽  
2006 ◽  
Vol 8 (01) ◽  
pp. 27-31 ◽  
Author(s):  
Giuseppe Lippi ◽  
Martina Montagnana ◽  
Gian Luca Salvagno ◽  
Gian Cesare Guidi
Keyword(s):  
Myocardial Ischemia ◽  
Acute Coronary Syndromes ◽  
Early Recognition ◽  
Myocardial Dysfunction ◽  
Acute Chest Pain ◽  
Diagnostic Approach ◽  
Time Of Arrival ◽  
New Era ◽  
Coronary Syndromes ◽  
New Biomarkers

ABSTRACTThe diagnostic approach to acute coronary syndromes (ACS) remains one of the most difficult and controversial challenges facing emergency physicians. In recent years, cardiac troponins have emerged as the biochemical “gold standard” for diagnosis of patients with acute chest pain, enhancing our ability to recognize ACS. Early diagnosis and treatment of myocardial ischemia improve patient outcomes, but conventional markers are often nondiagnostic at the time of arrival at the emergency department. Promising new biomarkers, which appear earlier after the onset of ischemia, are being studied and integrated into clinical practice. Some are markers of myocyte necrosis, but others, including ischemia-modified albumin and natriuretic peptides, detect myocardial ischemia and myocardial dysfunction. The aim of the present article is to review the diagnostic approach to ACS, focusing on recent literature describing novel biochemical markers. If ongoing and future studies confirm their role in probability-based models risk assessment, a new era in the diagnostic approach to ACS may be dawning.

Chest pain and chest pain units

2018 ◽  
Author(s):  
Eric Durand ◽  
Aurès Chaib ◽  
Etienne Puymirat ◽  
Nicolas Danchin
Keyword(s):  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Acute Coronary Syndromes ◽  
Acute Chest Pain ◽  
The United States ◽  
Cardiac Biomarkers ◽  
Coronary Syndrome ◽  
Cardiology Department ◽  
Coronary Syndromes ◽  
Rule Out

Patients presenting at the emergency department with acute chest pain and suspected to represent an acute coronary syndrome were classically admitted as routine to the cardiology department, resulting in expensive and time-consuming evaluations. However, 2-5% of patients with acute coronary syndromes were discharged home inappropriately, resulting in increased mortality. To address the inability to exclude the diagnosis of acute coronary syndrome, chest pain units were developed, particularly in the United States. These provide an environment where serial electrocardiograms, cardiac biomarkers, and provocative testing can be performed to confirm or rule out an acute coronary syndrome. Eligible candidates include the majority of patients with non-diagnostic electrocardiograms. The results have been impressive; chest pain units have markedly reduced adverse events, while simultaneously increasing the rate of safe discharge by 36%. Despite evidence to suggest that care in chest pain units is more effective for such patients, the percentage of emergency or cardiology departments setting up chest pain units remains low in Europe.

Incidence of high-risk acute coronary syndromes and eligibility for glycoprotein IIb/IIIa inhibitors among patients admitted for possible myocardial ischemia

2002 ◽  
Vol 143 (1) ◽  
pp. 70-75 ◽  
Author(s):  
Michael C. Kontos ◽  
Joseph P. Ornato ◽  
Kristin L. Schmidt ◽  
James L. Tatum ◽  
Robert L. Jesse
Keyword(s):  
High Risk ◽  
Myocardial Ischemia ◽  
Acute Coronary Syndromes ◽  
Coronary Syndromes

Chest pain and chest pain units

2015 ◽  
Author(s):  
Eric Durand ◽  
Aures Chaib ◽  
Nicolas Danchin
Keyword(s):  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Acute Coronary Syndromes ◽  
Acute Chest Pain ◽  
The United States ◽  
Cardiac Biomarkers ◽  
Coronary Syndrome ◽  
Cardiology Department ◽  
Coronary Syndromes ◽  
Rule Out

Patients presenting at the emergency department with acute chest pain and suspected to represent an acute coronary syndrome were classically admitted as routine to the cardiology department, resulting in expensive and time-consuming evaluations. However, 2-5% of patients with acute coronary syndromes were discharged home inappropriately, resulting in increased mortality. To address the inability to exclude the diagnosis of acute coronary syndrome, chest pain units were developed, particularly in the United States. These provided an environment where serial electrocardiograms, cardiac biomarkers, and provocative testing could be performed to rule out an acute coronary syndrome. Eligible candidates included the majority of patients with non-diagnostic electrocardiograms and normal troponin measurements. The results have been impressive; chest pain units have markedly reduced adverse events, while simultaneously increasing the rate of safe discharge by 36%. Despite evidence to suggest that care in chest pain units is more effective for such patients, the percentage of emergency or cardiology departments setting up chest pain units remains very low in Europe.

scholarly journals Unpredictable Fall of Severe Emergent Cardiovascular Diseases Hospital Admissions During the COVID‐19 Pandemic: Experience of a Single Large Center in Northern Italy

2020 ◽  
Vol 9 (13) ◽  
Author(s):  
Mauro Toniolo ◽  
Francesco Negri ◽  
Marco Antonutti ◽  
Marco Masè ◽  
Domenico Facchin
Keyword(s):  
Cardiovascular Diseases ◽  
Acute Coronary Syndromes ◽  
Hospital Admissions ◽  
Early Recognition ◽  
Time Frame ◽  
Northern Italy ◽  
University Hospital ◽  
Tertiary Referral Center ◽  
Coronary Syndromes ◽  
The Impact

Background Northern Italy is one of the epicenters of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV 2) pandemic in Europe. The impact of the pandemic and the consequent lockdown on medical emergencies other than those SARS‐CoV 2 pandemic related is largely unknown. The aim of this study was to analyze the epidemiologic impact of coronavirus disease 2019 pandemic on hospital admission for severe emergent cardiovascular diseases ( SECD s) in a single Northern Italy large tertiary referral center. Methods and Results We quantified SECD s admissions to the Cardiology Division of Udine University Hospital between March 1, 2020 and March 31, 2020 and compared them with those of the same time frame during 2019. Compared with March 2019, we observed a significant reduction in all SECD s admissions: −30% for ST ‐segment–elevation acute coronary syndromes, −66% for non‐ ST ‐segment–elevation acute coronary syndromes and −50% for severe bradyarrhythmia. Conclusions A significant decrease in all SECD s admissions has been observed during the SARS‐CoV 2. pandemic and was unlikely caused by a reduction in the incidence of cardiovascular diseases. Fear of contagion may have contributed to the unpredictable drop of SECD s. Social education about early recognition of symptoms of life‐threatening cardiac conditions requiring appropriate care in a timely fashion may help to reduce this counterproductive phenomenon.

Percutaneous coronary interventions in acute coronary syndromes

2021 ◽  
pp. 549-564
Author(s):  
Andreas Mitsis ◽  
Marco Valgimigli
Keyword(s):  
Chest Pain ◽  
Acute Coronary Syndromes ◽  
Acute Chest Pain ◽  
Haemodynamic Instability ◽  
Dramatic Improvement ◽  
St Segment Elevation ◽  
P2y12 Inhibitors ◽  
St Segment ◽  
Percutaneous Coronary ◽  
Coronary Syndromes

Acute coronary syndromes (ACS) remain the most common disease in acute cardiovascular care. Historically, two groups of patients should be differentiated based on initial ECG features: patients with ongoing chest pain and persistent ST-segment elevation and patients with acute chest pain but no persistent ST-segment elevation. The first condition is defined as STEMI and requires immediate reperfusion by primary angioplasty or fibrinolytic therapy. The second condition is defined as NSTE-ACS and consists a big spectrum of cases range from patients free of symptoms at presentation to individuals with ongoing ischaemia, electrical or haemodynamic instability or cardiac arrest. The different types of ACS must be differentiated as their prognosis and therapeutic strategy varies. However, over the last years, the early and broad use of percutaneous coronary intervention (PCI) as well as innovations in the adjunctive antithrombotic medication, including more effective P2Y12-Inhibitors and new generation DES resulted to a dramatic improvement of the prognosis across the whole spectrum of ACS patients.

Biomarkers in acute coronary syndromes

2021 ◽  
pp. 400-408
Author(s):  
Jasper Boeddinghaus ◽  
Thomas Nestelberger ◽  
Raphael Twerenbold ◽  
Christian Mueller
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Risk Stratification ◽  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Acute Coronary Syndromes ◽  
Acute Chest Pain ◽  
High Sensitivity ◽  
Coronary Syndromes ◽  
Rule Out

Biomarkers, particularly high-sensitivity cardiac troponin T/I (hs-cTnT/I), play a major role in the early diagnosis and risk stratification of patients presenting with symptoms suggestive of an acute coronary syndrome such as acute chest pain. As heart specific markers of cardiomyocyte injury, hs-cTnT/I complement clinical assessment and the 12-lead electrocardiogram in the diagnosis of myocardial infarction, the risk stratification for life-threatening arrhythmias and death, and the triage towards early revascularization. Hs-cTnT/I allow the reliable measurement of cTnT/I concentrations around the 99th-percentile and in the normal range and increased the diagnostic accuracy for myocardial infarction at presentation. Absolute short-term changes in hs-cTnT/I within 1h or 2h further increase the diagnostic accuracy for myocardial infarction. The ESC hs-cTnT/I 0/1h-algorithms are assay-specific early triage algorithms optimized for the early rule-out and/or rule-in of myocardial infarction. They triage patients towards rule-out (about 60%), observe (about 25%), and rule-in (about 15%). Triage towards rule-out provides very high sensitivity (99%) and negative predictive value (>99%) for the safe rule-out of myocardial infarction, while triage towards rule-in provides high specificity (about 96%) and positive predictive value (about 75%) for myocardial infarction. Other biomarkers quantifying cardiomyocyte injury (e.g. CK-MB, CK, LDH, myosin-binding protein C) or other pathophysiological processes involved in acute coronary syndromes (e.g. copeptin, BNP, NT-proBNP) provide no or only very little incremental diagnostic value for myocardial infarction on top of the ESC hs-cTnT/I 0/1h-algorithms. However, the later provide incremental prognostic value for death and heart failure. Therefore, the use of BNP or NT-proBNP, as quantitative markers of hemodynamic stress and heart failure, should be considered.

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