Abstract 2618: Use of Myeloperoxidase in Chest Pain Evaluation in The Emergency Department

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Martin Möckel ◽  
Reinhold Müller ◽  
Christian Lueders ◽  
Janett Reiche ◽  
Christian Müller ◽  
...  
Keyword(s):  
Emergency Department ◽  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Troponin I ◽  
Adverse Outcome ◽  
Cardiac Events ◽  
Coronary Syndrome ◽  
Adverse Cardiac Events ◽  
Automated Immunoassay ◽  
Prognostic Power

Background Elevated levels of myeloperoxidase (MPO) have been reported to indicate adverse outcome in selected patients with chest pain and acute coronary syndrome (ACS) but no data exists on its value in the routine setting of an emergency department (ED). Patients and methods Initial MPO was assessed at admission in 432 consecutive patients presenting to the ED who were evaluated for an acute coronary syndrome. In a subset of 116 patients blood samples were also available after 6 and 12–36 hours. All patients were followed up for six weeks with respect to major adverse cardiac events (MACE) including death, re-admission for heart failure or ACS and unplanned repeat coronary revascularisation. MPO was measured using a fully automated immunoassay in development on the ARCHITECT® platform and its prognostic power was compared with serial cardiac troponin I using cut-offs of 198 pmol/L for MPO and 0.1 μg/L for troponin I. Results Incidence of MACE was 13% in this population. MPO was detectable in all samples with a median of 246.5 (range 18 – 4547) pmol/L at admission. MPO increased significantly after 6h and decreased again after 12–36h. In this low-risk population, initial MPO levels revealed a sensitivity (Sens) of 82.1% and a specificity (Spec) of 37.5% (p<0.0001) for MACE compared with 28.6% Sens and 81.1% Spec (p=0.09 n.s.) for initial troponin I. Sensitivity of both markers improved when available serial information was used (MPO: Sens 96.4, Spec 22.6, p<0.0001; troponin I: Sens 44.6%, Spec 76.1%, p<0.01). In serial troponin I negative patients (n=317), both, initial MPO (Sens 80.6%, Spec 42.7%, p<0.05) and serial MPO (Sens 93.5%, Spec 28.7%, p<0.01) still demonstrated significant discriminatory power. Conclusions MPO has independent prognostic value in unselected patients evaluated for ACS in the ED. However MPO levels vary widely over the first 24h hours and also lack specificity.

scholarly journals Comparison of the HEART and HEARTS3 scores to predict major adverse cardiac events in chest pain patients at the emergency department

2020 ◽  
pp. 102490792094407
Author(s):  
Hasan Aydin ◽  
Yasin Ozpinar ◽  
Ulas Karaoglu ◽  
Muhittin Issever ◽  
Huseyin Aygun ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Emergency Department ◽  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Cardiovascular Events ◽  
Major Adverse Cardiovascular Events ◽  
Cardiac Events ◽  
Coronary Syndrome ◽  
Adverse Cardiac Events ◽  
The Mean

Introduction: The aim of this study was to determine the risk assessment of acute coronary syndrome and prediction of major adverse cardiac events by HEART (History, ECG, Age, Risk factors, Troponin) and HEARTS3 (HEART + 3S = Sex, Serial 2-h ECG, and Serial 2-h delta Troponin) scoring systems in patients admitted to the emergency department with chest pain. Methods: This is a single-center prospective cohort study. This study was conducted in patients admitted to the emergency department with chest pain, without ST-elevation myocardial infarction, who were 18 years or older, and agreed to participate in the study. The primary endpoint is the occurrence of major adverse cardiovascular events within 30 days. The receiver operating characteristic curve was used to assess the power of HEART and HEARTS3 scores to predict major adverse cardiovascular events. Results: The mean age of 239 patients was 47.91 ± 13.93 years and 72.4% (173) were male. Major adverse cardiovascular events developed in 20.1% (48) of the patients. The mean HEART and HEARTS3 scores of the patients with major adverse cardiovascular events (5.67 ± 1.46 and 9.38 ± 3.91, respectively) were both statistically and significantly higher than the scores of the patients without major adverse cardiovascular events (2.33 ± 1.44 and 2.22 ± 1.39; p = 0.001). The area under the curve values of HEART and HEARTS3 scores were found to be 0.943 (95% confidence interval: 0.905–0.968) and 0.990 (0.968–0.999), respectively. Conclusion: In our study, the power of HEARTS3 score to predict major adverse cardiovascular events was better in the risk assessment of acute coronary syndrome in patients admitted to the emergency department with chest pain compared to the HEART score. We think that patients with a low HEARTS3 score can be safely discharged from emergency department without further cardiac examination.

scholarly journals Validation of the new Vancouver Chest Pain Rule in Asian chest pain patients presenting at the emergency department

CJEM ◽  
2016 ◽  
Vol 19 (1) ◽  
pp. 18-25 ◽  
Author(s):  
Marcus Eng Hock Ong ◽  
Ying Hao ◽  
Susan Yap ◽  
Pin Pin Pek ◽  
Terrance Siang Jin Chua ◽  
...  
Keyword(s):  
Emergency Department ◽  
Chest Pain ◽  
Coronary Artery ◽  
Artery Bypass ◽  
Early Discharge ◽  
Cardiac Events ◽  
Urban Centre ◽  
Coronary Syndrome ◽  
Adverse Cardiac Events ◽  
Pain Patients

AbstractObjectivesThe new Vancouver Chest Pain (VCP) Rule recommends early discharge for chest pain patients who are at low risk of developing acute coronary syndrome (ACS), and thus can be discharged within 2 hours of arrival at the emergency department (ED). This study aimed to assess the performance of the new VCP Rule for Asian patients presenting with chest pain at the ED.MethodsThis prospective cohort study involved patients attended to at the ED of a large urban centre. Patients of at least 25 years old, presenting with stable chest pain and a non-diagnostic ECG, and with no history of active coronary artery disease were included in the study. The main outcome measures were cardiac events, angioplasty, or coronary artery bypass within 30 days of enrolment.ResultsThe study included 1690 patients from 27 August 2000 to 1 May 2002, with 661 patients fulfilling the VCP criteria. Of those for early discharge, 24 had cardiac events and 13 had angioplasty or bypass at 30 days, compared to 91 and 41, respectively, for those unsuitable for discharge. This gave the rule a sensitivity of 78.1% for cardiac events, including angioplasty and bypass. Specificity was 41.0%, and negative predictive value (NPV) was 94.4%.ConclusionWe found the new VCP Rule to have moderate sensitivity and poor specificity for adverse cardiac events in our population. With an NPV of less than 100%, this means that a small proportion of patients sent home with early discharge would still have adverse cardiac events.

Assessing the Performance of a Novel Point-of-Care Qualitative Assay for Early Diagnosis of Acute Coronary Syndrome

Cardiology ◽  
2020 ◽  
pp. 1-8
Author(s):  
Ronny Alcalai ◽  
Boris Varshisky ◽  
Ahmad Marhig ◽  
David Leibowitz ◽  
Larissa Kogan-Boguslavsky ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Diagnostic Accuracy ◽  
Diagnostic Performance ◽  
Troponin I ◽  
Point Of Care ◽  
Final Diagnosis ◽  
Cardiac Biomarkers ◽  
Fatty Acid Binding ◽  
Coronary Syndrome

<b><i>Background:</i></b> Early and accurate diagnosis of acute coronary syndrome (ACS) is essential for initiating lifesaving interventions. In this article, the diagnostic performance of a novel point-of-care rapid assay (SensAheart<sup>©</sup>) is analyzed. This assay qualitatively determines the presence of 2 cardiac biomarkers troponin I and heart-type fatty acid-binding protein that are present soon after onset of myocardial injury. <b><i>Methods:</i></b> We conducted a prospective observational study of consecutive patients who presented to the emergency department with typical chest pain. Simultaneous high-sensitive cardiac troponin T (hs-cTnT) and SensAheart testing was performed upon hospital admission. Diagnostic accuracy was computed using SensAheart or hs-cTnT levels versus the final diagnosis defined as positive/negative. <b><i>Results:</i></b> Of 225 patients analyzed, a final diagnosis of ACS was established in 138 patients, 87 individuals diagnosed with nonischemic chest pain. In the overall population, as compared to hs-cTnT, the sensitivity of the initial SensAheart assay was significantly higher (80.4 vs. 63.8%, <i>p</i> = 0.002) whereas specificity was lower (78.6 vs. 95.4%, <i>p</i> = 0.036). The overall diagnostic accuracy of SensAheart assay was similar to the hs-cTnT (82.7% compared to 76.0%, <i>p</i> = 0.08). <b><i>Conclusions:</i></b> Upon first medical contact, the novel point-of-care rapid SensAheart assay shows a diagnostic performance similar to hs-cTnT. The combination of 2 cardiac biomarkers in the same kit allows for very early detection of myocardial damage. The SensAheart assay is a reliable and practical tool for ruling-in the diagnosis of ACS.

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