Evaluating Diagnostic and Prognostic Value of Plasma miRNA133a in Acute Chest Pain Patients Undergoing Coronary Angiography

Elevated plasma levels of long pentraxin 3 (PTX3), high-sensitive C-reactive protein (hsCRP) and B-type natriuretic peptide (BNP) are found in acute coronary syndromes (ACS). The aim of this study was to assess the prognostic value of PTX3 as compared to BNP and hsCRP, and their combination, as a prognostic marker of mortality in acute chest pain patients. PTX3 was measured in EDTA plasma with a new, high-sensitive ELISA method (PPMX, Tokyo, Japan). BNP was analysed in EDTA plasma using the Microparticle Enzyme Immunoassay (MEIA) Abbott AxSYM®. HsCRP was measured with the use of an immunoturbidimetric assay (Tinaquant® C-reactive protein (latex) high sensitive assay, Roche Diagnostics). The blood samples were taken on admission in 795 patients. The patients were followed for 24 months concerning mortality. For statistical analysis, the study cohort was divided into quartiles (Q1–4) according to PTX3 levels. A multiple logistic regression was fitted which included standard risk measures. At 24 months follow-up, 121 of the 784 patients included in the model had died. The odds ratio for comparing Q4 versus Q1 for PTX3, BNP and hsCRP were 4.34, 3.35 and 0.52 (p=0.001, p=0.024 and p=0.096), respectively, and the combination of PTX3 and BNP showed an incremental prognostic value (figure ). PTX3 is a new independent marker that strongly predicts long-term all-cause mortality in patients with acute chest pain and the combination of this marker with BNP adds substantially to the prognostic value as compared to either marker alone. Figure The number of biomakers greater than the median for % death in 24 months (p<0.001 for comparing the groups)

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Faculty Opinions recommendation of The CT-STAT (Coronary Computed Tomographic Angiography for Systematic Triage of Acute Chest Pain Patients to Treatment) trial.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.13382965.14750190 ◽

2011 ◽

Author(s):

Christopher Kramer

Keyword(s):

Chest Pain ◽

Acute Chest Pain ◽

Computed Tomographic Angiography ◽

Treatment Trial ◽

Coronary Computed Tomographic Angiography ◽

Computed Tomographic ◽

Tomographic Angiography ◽

Pain Patients

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Faculty Opinions recommendation of High-sensitivity troponin T concentrations in acute chest pain patients evaluated with cardiac computed tomography.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.2811956.2477054 ◽

2010 ◽

Author(s):

Christopher de Filippi ◽

Puneet Gandotra

Keyword(s):

Computed Tomography ◽

Chest Pain ◽

Troponin T ◽

Cardiac Computed Tomography ◽

Acute Chest Pain ◽

High Sensitivity ◽

High Sensitivity Troponin ◽

High Sensitivity Troponin T ◽

Pain Patients

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The Value of Dual-source 64-Slice CT Coronary Angiography in the Assessment of Patients Presenting to an Acute Chest Pain Service

Heart Lung and Circulation ◽

10.1016/j.hlc.2010.01.004 ◽

2010 ◽

Vol 19 (4) ◽

pp. 213-218 ◽

Cited By ~ 19

Author(s):

Mark Hansen ◽

Jonathan Ginns ◽

Sujith Seneviratne ◽

Richard Slaughter ◽

Manuja Premaranthe ◽

...

Keyword(s):

Chest Pain ◽

Coronary Angiography ◽

Acute Chest Pain ◽

Ct Coronary Angiography ◽

Dual Source

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Long-term prognostic value of peak exercise echocardiogram in patients hospitalized with acute chest pain

Echocardiography ◽

10.1111/echo.13530 ◽

2017 ◽

Vol 34 (6) ◽

pp. 869-875 ◽

Cited By ~ 1

Author(s):

German Merchan Ortega ◽

Juan Carlos Bonaque Gonzalez ◽

Alejandro Dionisio Sanchez Espino ◽

Maria Jose Aguado Martin ◽

Francisco Navarro Garcia ◽

...

Keyword(s):

Chest Pain ◽

Prognostic Value ◽

Acute Chest Pain ◽

Peak Exercise

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Abstract 16639: Low Yield of Additional Non-invasive Testing in Moderate Worst Stenosis by cCTA in Acute Chest Pain Patients - Results From a Clinical ED cCTA Registry

Circulation ◽

10.1161/circ.132.suppl_3.16639 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Sumbal A Janjua ◽

Harshna V Vadvala ◽

Pedro V Staziaki ◽

Richard A Takx ◽

Anand M Prabhakar ◽

...

Keyword(s):

Myocardial Infarction ◽

Chest Pain ◽

Unstable Angina ◽

Acute Chest Pain ◽

Left Ventricular ◽

Fractional Flow ◽

Coronary Syndrome ◽

Non Invasive ◽

Lipid Rich Plaque ◽

Pain Patients

Introduction: Coronary computed tomography angiography (cCTA) allows efficient triage of low-intermediate risk patients with suspected acute coronary syndrome (ACS); appropriate management of patients with moderate stenosis by cCTA is unknown. We evaluated the yield of downstream testing in moderate stenosis patients in a clinical ED cCTA registry. Methods: All consecutive ED patients with acute chest pain undergoing cCTA as part of routine care between October 2012 and July 2014 were screened. Patients with moderate as their worst stenosis (50-69% stenosis) on cCTA were included. Plaque characteristics, resting left ventricular function (by cCTA), results of any functional downstream non-invasive testing, invasive coronary angiography (ICA) and interventions, and discharge diagnosis were reported. ACS was defined as acute myocardial infarction (MI) or unstable angina pectoris (UAP) and adjudicated by an independent committee. Ischemia was defined as clear, territorial abnormality by myocardial perfusion scintigraphy imaging (MPI) or rest or stress echocardiogram, significant dynamic ST-T shift by exercise treadmill test (ETT) and stenosis >70% on ICA or fractional flow reserve (FFR) <0.75. Results: 586 patients underwent cCTA, with 7.2% (n=42) deemed moderate stenosis. Rate of ACS was 14.2% (n=6) with all adjudicated as UAP. Of these, 83% had stenosis caused by lipid-rich plaque; 33% had wall motion abnormalities on cCTA. The majority (n=28; 66%) underwent downstream non-invasive testing. Overall, n=2 (6%) of the non-invasive tests were positive for ischemia while n=3 (42%) of the invasive tests were diagnosed as positive for ischemia (all revascularized) (Figure 1). Conclusions: Unstable angina but not myocardial infarction is frequent among acute chest pain patients with moderate stenosis by cCTA. cCTA findings of lipid-rich plaque and resting functional abnormalities had a relatively higher yield vs. other non-invasive tests to detect ischemia.

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