Biomarkers for predicting serious cardiac outcomes at 72 hours in patients presenting early after chest pain onset with symptoms of acute coronary syndromes

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 biom...

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Bibliographic Details
Published in:Clinical chemistry (Baltimore, Md.) Md.), 2012-01, Vol.58 (1), p.298-302
Main Authors: Kavsak, Peter A, Hill, Stephen A, Bhanich Supapol, Wendy, Devereaux, Philip J, Worster, Andrew
Format: Article
Language:English
Subjects:
Acute Coronary Syndrome - diagnosis
Acute Coronary Syndrome - mortality
Acute coronary syndromes
Area Under Curve
Arrhythmias, Cardiac - diagnosis
Biomarkers - blood
Cardiology
Chest Pain - diagnosis
Chest Pain - mortality
Clinical outcomes
Heart attacks
Heart Failure - diagnosis
Humans
Medical research
Myocardial infarction
Myocardial Infarction - diagnosis
Pain
Predictive Value of Tests
ROC Curve
Studies
Time Factors
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Summary: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. 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. 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
ISSN:0009-9147
1530-8561
DOI:10.1373/clinchem.2011.172064