scholarly journals Biomarkers for Predicting Serious Cardiac Outcomes at 72 Hours in Patients Presenting Early after Chest Pain Onset with Symptoms of Acute Coronary Syndromes

2012 ◽  
Vol 58 (1) ◽  
pp. 298-302 ◽  
Author(s):  
Peter A Kavsak ◽  
Stephen A Hill ◽  
Wendy Bhanich Supapol ◽  
Philip J Devereaux ◽  
Andrew Worster
Keyword(s):  
Emergency Department ◽  
Creatine Kinase ◽  
Chest Pain ◽  
Roc Curve ◽  
Cardiac Troponin ◽  
Acute Coronary Syndromes ◽  
Troponin I ◽  
Diagnostic Sensitivity ◽  
Cardiac Outcomes ◽  
Coronary Syndromes

Abstract BACKGROUND Most outcome studies of patients presenting early to the emergency department with potential acute coronary syndromes have focused on either the index diagnosis of myocardial infarction (MI) or a composite end point at a later time frame (30 days or 1 year). We investigated the performance of 9 biomarkers for an early serious outcome. METHODS Patients (n = 186) who presented to the emergency department within 6 h of chest pain onset had their presentation serum sample measured for the following analytes: creatine kinase, creatine kinase isoenzyme MB, enhanced AccuTnI troponin I (Beckman Coulter), high-sensitivity cardiac troponin T (hs-cTnT), ischemia-modified albumin, interleukin-6, investigation use only hs-cTnI (Beckman Coulter), N-terminal pro–B-type natriuretic peptide, and cardiac troponin I (Abbott AxSym). We followed patients until 72 h after presentation and determined whether they experienced the following serious cardiac outcomes: MI, heart failure, serious arrhythmia, refractory ischemic cardiac pain, or death. ROC curves were analyzed to determine the area under the ROC curve (AUC) and optimal cutoffs for the biomarkers. RESULTS The AUCs for the hs-cTnI assay (0.86; 95% CI, 0.76–0.96), the AccuTnI assay (0.86; 95% CI, 0.78–0.95), and the hs-cTnT assay (0.82; 95% CI, 0.71–0.94) assays were significantly higher than those for the other 6 assays (AUC values ≤0.71 for the rest of the biomarkers, P < 0.05). The ROC curve–derived optimal cutoffs were ≥19 ng/L (diagnostic sensitivity, 80%; specificity, 88%), ≥0.018 μg/L (diagnostic sensitivity, 75%; specificity, 86%), and ≥32 ng/L (diagnostic sensitivity, 68%; specificity, 92%) for the hs-cTnI, AccuTnI, and hs-cTnT assays, respectively. CONCLUSIONS The optimal cutoffs for predicting serious cardiac outcomes in this low-risk population are different from the published 99th percentiles. Larger studies are required to verify these findings.

scholarly journals Comparison of Myocardial Perfusion Imaging and Cardiac Troponin I in Patients Admitted to the Emergency Department With Chest Pain

Circulation ◽  
1999 ◽  
Vol 99 (16) ◽  
pp. 2073-2078 ◽  
Author(s):  
Michael C. Kontos ◽  
Robert L. Jesse ◽  
F. Philip Anderson ◽  
Kristin L. Schmidt ◽  
Joseph P. Ornato ◽  
...  
Keyword(s):  
Emergency Department ◽  
Chest Pain ◽  
Myocardial Perfusion Imaging ◽  
Myocardial Perfusion ◽  
Perfusion Imaging ◽  
Cardiac Troponin ◽  
Troponin I ◽  
Cardiac Troponin I

scholarly journals The Use of Biochip Cardiac Array Technology for Early Diagnosis of Acute Coronary Syndromes

2009 ◽  
Vol 28 (4) ◽  
pp. 293-299 ◽  
Author(s):  
Grazyna Sypniewska ◽  
Marcin Sawicki ◽  
Magdalena Krintus ◽  
Marek Kozinski ◽  
Jacek Kubica
Keyword(s):  
Early Diagnosis ◽  
Cardiac Troponin ◽  
Acute Coronary Syndromes ◽  
Myocardial Injury ◽  
Troponin I ◽  
Reference Population ◽  
Coronary Syndrome ◽  
Carbonic Anhydrase Iii ◽  
Array Technology ◽  
Coronary Syndromes

The Use of Biochip Cardiac Array Technology for Early Diagnosis of Acute Coronary SyndromesSerum troponin is the best biomarker for the diagnosis of acute coronary syndrome, but it takes considerable time before a definitive diagnosis is available. The purpose of this study was to evaluate whether a multimarker approach, using the biochip cardiac array, would facilitate the early diagnosis. Serum biomarkers were determined on admission (≤6 hrs) and after 6 hours in 42 patients suspected for ACS. Cardiac troponin I was measured by a sensitive assay (STATcTnI) and cardiac markers (H-FABP, myoglobin, cTnI, CK-MB mass, carbonic anhydrase III) were assayed with the use of Biochip Array Technology.STATcTnI concentrations, within the first 6 hours, were elevated >99thpercentile for the reference population in 83.3% of subjects, but none reached the cut-off for AMI. On admission H-FABP was the only marker with 90.5% sensitivity in all ACS cases and 100% sensitivity in STEMI/NSTEMI patients. The sensitivity of myoglobin at presentation was 71.4% in ACS, however, combined sensitivity of myoglobin and H-FABP reached 95.2%. Lowering the cut-off for cTnI allowed early diagnosis (≤6 hrs) in only 26.2% of ACS patients and 95.2% after the next 6 hours. In unstable angina the cardiac panel was not sufficiently accurate for early risk stratification. In conclusion, testing for both markers, H-FABP and sensitive cardiac troponin, available with the cardiac array may facilitate the early detection of myocardial injury in clinical practice.

ST2 in Emergency Department Chest Pain Patients with Potential Acute Coronary Syndromes

2007 ◽  
Vol 14 (5 Supplement 1) ◽  
pp. S119-S119
Author(s):  
A. Brown ◽  
A. H.B. Wu ◽  
P. Clopton ◽  
J. Robey ◽  
J. Hollander
Keyword(s):  
Emergency Department ◽  
Chest Pain ◽  
Acute Coronary Syndromes ◽  
Coronary Syndromes ◽  
Pain Patients

scholarly journals Validation of High sensitivity cardiac troponin (HsTnI) – a breakthrough in diagnostic accuracy of acute coronary syndromes

2021 ◽  
Vol 156 (Supplement_1) ◽  
pp. S35-S35
Author(s):  
S Dalal ◽  
J M Petersen ◽  
D Jhala
Keyword(s):  
Cardiac Troponin ◽  
Acute Coronary Syndromes ◽  
Troponin I ◽  
Clinical Laboratory ◽  
Clinical Chemistry ◽  
Method Comparison ◽  
Heart Association ◽  
High Sensitivity ◽  
Coronary Syndromes ◽  
European Society Of Cardiology

Abstract Introduction/Objective Cardiac troponin (cTn) testing is an essential component of the diagnostic workup and management of acute coronary syndromes (ACS). Rapid advances in immunoassay technologies has led to the development of high sensitivity troponin (HsTnl) assays with unprecedented analytic sensitivity and precision. These assays are FDA approved and the use of HsTnl assays is recommended by the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC), the Joint European Society of Cardiology (ESC), the American College of Cardiology (ACC), and the American Heart Association (AHA) in the Fourth Universal Definition of Myocardial Infarction (2018). The incidence of ACS and its mimics in emergency room visits are much more prevalent in veterans due to increased medical comorbidities. We report here our experience with its validation on two Unicel DXI 800 Access Immunoassays as it has not been well published, particularly in a Veterans Healthcare Clinical Laboratory setting. Methods/Case Report The quality assurance goal of the validation is to demonstrate that the Unicel DXI 800 Access Immunoassay HsTnl assay performs as expected on two analyzers and can be put into clinical use. Method to method correlation with a validated conventional Troponin I, within run precision, day to day precision, and a linearity study were performed as part of this validation. Results (if a Case Study enter NA) For the total of 60 specimens run for the method comparison, Data was plotted and evaluated against EP evaluator, both hsTnI and Troponin I were within the 95% confidence intervals of the method. The linearity study demonstrated results are linear with results as expected. Two levels of cardiac control were tested in a run of 60 replicates each in one day for within run precision, with all results as expected. The day to day precision with three levels of control run daily over 10 days also yielded results as expected. Conclusion The HsTnI is a highly accurate, faster test for the detection of ACS allowing earlier detection of smaller infarcts with much better precision, and there by reducing the morbidity and mortality. It allows rapid discharge of the patients with reducing the cost of hospital stay. This is an example of excellence in laboratory practice by extending the best quality laboratory care with proper validation of instrument methods conducive to laboratory workflow.

scholarly journals NILAI DIAGNOSTIK UJI TROPONIN I KUANTITATIF METODE IMMUNOKROMATOGRAFI

2018 ◽  
Vol 14 (1) ◽  
pp. 20
Author(s):  
Siti Fatonah ◽  
Anik Widijanti ◽  
Tinny Endang Hernowati
Keyword(s):  
Cardiac Troponin ◽  
Biochemical Markers ◽  
Acute Coronary Syndromes ◽  
Troponin I ◽  
Myocardial Damage ◽  
Diagnostic Value ◽  
Cardiac Troponin I ◽  
Coronary Syndromes ◽  
Sensitivity Specificity ◽  
Cardiac Troponins

Cardiac troponins are the most sensitive and specific biochemical markers of myocardial damage but there is no standardization of WHO for cardiac troponin I, resulting in a variability for diagnostic value. It is necessary to determine diagnostic value for a new kitof troponin I. To evaluate a new quantitative immunochromatography assay for troponin I at a various cut off level. A cross sectionalstudy was conducted in 64 patients with acute myocardial infarction (AMI) and 55 non-AMI as control from February to September2007. The level of cardiac troponin I (cTnI) was measured and determined it diagnostic value at a various cut off level. The sensitivity,specificity, PPV and NPV of this assay were 91%, 91%, 92% and 89% at cut off level of 1,0 ng/ml (according to the kit), respectively.The cut off of cTnI were divided into five levels: 0.8, 1.0, 1.2, 1.5, and 2.0 with the area under curve were 0.923, 0.908, 0.912, and0.897, respectively. The sensitivity were 94%, 91%, 86%, 81% and 72%, respectively, the specificity were 91%, 91%, 96%, 98% and98%, respectively. This rapid diagnostic test is sensitive and specific to diagnose an acute coronary syndromes.

Cardiology

2019 ◽  
pp. 19-50
Author(s):  
Ashis Banerjee ◽  
Anisa J. N. Jafar ◽  
Angshuman Mukherjee ◽  
Christian Solomonides ◽  
Erik Witt
Keyword(s):  
Atrial Fibrillation ◽  
Emergency Department ◽  
Chest Pain ◽  
Acute Coronary Syndromes ◽  
Short Answer ◽  
Coronary Syndromes ◽  
Accompanying Symptoms ◽  
Short Answer Questions ◽  
Emergency Doctor

This chapter on cardiology contains 16 clinical Short Answer Questions (SAQs) with explanations and sources for further reading. Possible causes and accompanying symptoms of heart problems that may present in the emergency department include acute coronary syndromes, atrial fibrillation, palpitations, bradycardia, chest pain, dyspnoea, and syncope. The emergency doctor has to assess, diagnose, and decide upon a treatment path for each patient. The cases described in this chapter are all situations any emergency doctor is likely to encounter at some point in his or her career. Material in this chapter will greatly aid revision for the Final FRCEM examination.

ST2 in Emergency Department Chest Pain Patients With Potential Acute Coronary Syndromes

2007 ◽  
Vol 50 (2) ◽  
pp. 153-158.e1 ◽  
Author(s):  
Aaron M. Brown ◽  
Alan H.B. Wu ◽  
Paul Clopton ◽  
Jennifer L. Robey ◽  
Judd E. Hollander
Keyword(s):  
Emergency Department ◽  
Chest Pain ◽  
Acute Coronary Syndromes ◽  
Coronary Syndromes ◽  
Pain Patients
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