Combined Use of High-Sensitive Cardiac Troponin, Copeptin, and the Modified HEART Score for Rapid Evaluation of Chest Pain Patients.

Détails

Ressource 1Télécharger: 30538785_BIB_8EBCA74F97CA.pdf (688.80 [Ko])
Etat: Public
Version: Final published version
Licence: CC BY 4.0
ID Serval
serval:BIB_8EBCA74F97CA
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Combined Use of High-Sensitive Cardiac Troponin, Copeptin, and the Modified HEART Score for Rapid Evaluation of Chest Pain Patients.
Périodique
Disease markers
Auteur(s)
Morawiec B., Przywara-Chowaniec B., Muzyk P., Opara M., Ho L., Tat L.C., Muller O., Nowalany-Kozielska E., Kawecki D.
ISSN
1875-8630 (Electronic)
ISSN-L
0278-0240
Statut éditorial
Publié
Date de publication
2018
Peer-reviewed
Oui
Volume
2018
Pages
9136971
Langue
anglais
Notes
Publication types: Journal Article
Publication Status: epublish
Résumé
Clinical short-term risk stratification is a recommended approach in patients with chest pain and possible acute myocardial infarction (AMI) to further improve high safety of biomarker-based rule-out algorithms. The study aim was to assess clinical performance of baseline concentrations of high-sensitivity cardiac troponin T (hs-TnT) and copeptin and the modified HEART score (mHS) in early presenters to the emergency department with chest pain.
This cohort study included patients with chest pain with onset maximum of 6 h before admission and no persistent ST-segment elevation on electrocardiogram. hs-TnT, copeptin, and the mHS were assessed from admission data. The diagnostic and prognostic value for three baseline rule-out algorithms: (1) single hs-TnT < 14 ng/l, (2) hs-TnT < 14 ng/l/mHS ≤ 3, and (3) hs-TnT < 14 ng/l/mHS ≤ 3/copeptin < 17.4 pmol/l, was assessed with sensitivity and negative predictive value. Primary diagnostic endpoint was the diagnosis of AMI. Prognostic endpoint was death and/or AMI within 30 days.
Among 154 enrolled patients, 44 (29%) were classified as low-risk according to the mHS; AMI was diagnosed in 105 patients (68%). For ruling out AMI, the highest sensitivity and NPV from all studied algorithms were observed for hs-TnT/mHS/copeptin (100%, 95% CI 96.6-100, and 100%, 95% CI 75.3-100). At 30 days, the highest event-free survival was achieved in patients stratified with hs-TnT/mHS/copeptin algorithm (100%) with 100% (95% CI 75.3-100) NPV and 100% (95% CI 96.6-100) sensitivity.
The combination of baseline hs-TnT, copeptin, and the mHS has an excellent sensitivity and NPV for short-term risk stratification. Such approach might improve the triage system in emergency departments and be a bridge for inclusion to serial blood sampling algorithms.
Mots-clé
Aged, Algorithms, Biomarkers/blood, Chest Pain/blood, Chest Pain/etiology, Chest Pain/mortality, Chest Pain/physiopathology, Cohort Studies, Cross-Sectional Studies, Electrocardiography, Emergency Service, Hospital, Female, Glycopeptides/blood, Humans, Male, Middle Aged, Myocardial Infarction/blood, Myocardial Infarction/diagnosis, Myocardial Infarction/mortality, Predictive Value of Tests, Prognosis, Prospective Studies, Troponin T/blood
Pubmed
Web of science
Open Access
Oui
Création de la notice
05/01/2019 16:43
Dernière modification de la notice
20/08/2019 15:52
Données d'usage