Kai M Eggers1, Per Venge, Bertil Lindahl. 1. Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden. kai.eggers@ucr.uu.se
Abstract
BACKGROUND: Measurement of high-sensitive cardiac troponin (hs-cTn) has facilitated the early diagnostic assessment of chest pain patients. However, the information obtained from hs-cTnT levels might be improved when combined with results of other biomarkers of myocardial injury. METHODS: We measured admission levels of hs-cTnT (Roche Diagnostics), heart-type fatty-acid binding protein (H-FABP; Randox Laboratories) and copeptin using a novel ultra-sensitive (us) assay (Thermo Fisher Scientific) in 360 chest pain patients with a non-diagnostic ECG. Non-STEMI was defined according to the Universal Definition using cardiac troponin I (Stratus CS; Siemens Healthcare Diagnostics) as biochemical gold standard. RESULTS: Non-STEMI was diagnosed in 128 (36%) patients. Hs-cTnT had a greater diagnostic accuracy regarding non-STEMI (C-statistics 0.84) compared to H-FABP (C-statistics 0.80; p=0.04) and us-copeptin C-statistics(0.62; p<0.001). Compared to hs-cTnT alone, no increase in the C-statistics was noted for the combination of hs-cTnT with H-FABP (0.85; p=0.43) or with us-copeptin (0.84; p=0.88). Due to suboptimal sensitivities and/or specificities, neither H-FABP nor us-copeptin dichotomized at commonly applied diagnostic thresholds added information to hs-cTnT that would have facilitated early diagnostic assessment. CONCLUSIONS: Hs-cTnT provides an excellent early diagnostic accuracy regarding non-STEMI already on admission. Neither H-FABP nor us-copeptin perform better or provide diagnostic increment to hs-cTnT levels.
BACKGROUND: Measurement of high-sensitive cardiac troponin (hs-cTn) has facilitated the early diagnostic assessment of chest painpatients. However, the information obtained from hs-cTnT levels might be improved when combined with results of other biomarkers of myocardial injury. METHODS: We measured admission levels of hs-cTnT (Roche Diagnostics), heart-type fatty-acid binding protein (H-FABP; Randox Laboratories) and copeptin using a novel ultra-sensitive (us) assay (Thermo Fisher Scientific) in 360 chest painpatients with a non-diagnostic ECG. Non-STEMI was defined according to the Universal Definition using cardiac troponin I (Stratus CS; Siemens Healthcare Diagnostics) as biochemical gold standard. RESULTS: Non-STEMI was diagnosed in 128 (36%) patients. Hs-cTnT had a greater diagnostic accuracy regarding non-STEMI (C-statistics 0.84) compared to H-FABP (C-statistics 0.80; p=0.04) and us-copeptin C-statistics(0.62; p<0.001). Compared to hs-cTnT alone, no increase in the C-statistics was noted for the combination of hs-cTnT with H-FABP (0.85; p=0.43) or with us-copeptin (0.84; p=0.88). Due to suboptimal sensitivities and/or specificities, neither H-FABP nor us-copeptin dichotomized at commonly applied diagnostic thresholds added information to hs-cTnT that would have facilitated early diagnostic assessment. CONCLUSIONS: Hs-cTnT provides an excellent early diagnostic accuracy regarding non-STEMI already on admission. Neither H-FABP nor us-copeptin perform better or provide diagnostic increment to hs-cTnT levels.
Authors: Harsh Goel; Joshua Melot; Matthew D Krinock; Ashish Kumar; Sunil K Nadar; Gregory Y H Lip Journal: Ann Med Date: 2020-08-04 Impact factor: 4.709
Authors: Judith M Poldervaart; Emma Röttger; Marieke S Dekker; Nicolaas P A Zuithoff; Peter W H M Verheggen; Evelyn A de Vrey; Thierry X Wildbergh; Arnoud W J van 't Hof; Arend Mosterd; Arno W Hoes Journal: PLoS One Date: 2015-07-15 Impact factor: 3.240
Authors: Martin Möckel; Julia Searle; Christian Hamm; Anna Slagman; Stefan Blankenberg; Kurt Huber; Hugo Katus; Christoph Liebetrau; Christian Müller; Reinhold Muller; Philipp Peitsmeyer; Johannes von Recum; Milos Tajsic; Jörn O Vollert; Evangelos Giannitsis Journal: Eur Heart J Date: 2014-04-30 Impact factor: 29.983