Bedside Multimarker Testing for Risk Stratification in Chest Pain Units

Apple, Fred S.; Jaffe, Allan S.

doi:10.1161/01.cir.103.14.1832

Cited by 232 publications

(33 citation statements)

References 23 publications

(19 reference statements)

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“…Recent studies indicated that a combination of myoglobin with CK-MB and the troponins may represent a good marker of heart damage but not of skeletal muscle damage. 18 Myoglobin levels within the normal range 19 were found in the present study, with the exception of the non-sportspeople with skeletal muscle injury. Although higher myoglobin levels were shown in injured than in non-injured sportspeople, they were both considerably lower than those observed in injured non-sportspeople.…”

Section: Discussionsupporting

confidence: 59%

Role of α-actin in muscle damage of injured athletes in comparison with traditional markers

et al. 2007

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Objective: In order to identify a reliable marker for the early detection of muscle injuries in sports, a-actin protein and other markers of muscle damage were studied in sera of uninjured sportspeople and those with skeletal muscle injury. Methods: Blood samples were obtained from 20 sportspeople with skeletal muscle injury and 48 uninjured sportspeople. Immunoassays were performed to determine cardiac troponin I (TnI), troponin T, lactate dehydrogenase and myoglobin concentrations. Western blot and densitometry were used to measure a-actin concentrations. Skeletal muscle damage was diagnosed according to physical examination, MRI findings and the biochemical criterion of a creatine kinase value .500 IU/l (Rosalki method, Beckman Instruments SL, Fullerton, California, USA). Results were also compared with previously obtained data on injured and uninjured non-sportspeople. Results: The mean serum concentration of a-actin was significantly higher in sportspeople with muscle damage (10.49 mg/ml) than in uninjured sportspeople (3.99 mg/ml). Sera from injured sportspeople showed higher levels of a-actin than of troponin or myoglobin. No significant difference in TnI levels was observed between the groups. Conclusions: According to these results, a-actin is a new and reliable marker of skeletal muscle damage in sportspeople which can be used for the detection of muscle injury. Possible cross interference between skeletal and cardiac muscle damage can be discriminated by the combined use of a-actin and TnI. These data suggest that early measurement of a-actin in sportspeople with suspected muscle damage will allow them to receive earlier and more effective treatment and to return sooner to the practice of their sport.

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Section: Discussionsupporting

confidence: 59%

Role of α-actin in muscle damage of injured athletes in comparison with traditional markers

et al. 2007

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“…Newby et al 9 demonstrated earlier identification of myocardial infarction than laboratory testing and Carragher et al 10 showed expedited decision-making with turnaround times reduced by 55%, but it was not clear whether these led to meaningful changes in patient care. Ng et al 11 compared management with the panel to previous practice and showed a 40% reduction in coronary care unit admissions.…”

Section: Discussionmentioning

confidence: 99%

The Randomised Assessment of Treatment using Panel Assay of Cardiac Markers (RATPAC) trial: a randomised controlled trial of point-of-care cardiac markers in the emergency department

Goodacre

Bradburn²,

Cross³

et al. 2010

Heart

124

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Objectives To determine whether using a point-of-care cardiac biomarker panel would increase the rate of successful discharge home after emergency department assessment, and affect the use of cardiac tests and treatments, subsequent attendance at or admission to hospital and major adverse events. Design and setting Pragmatic multicentre randomised controlled trial in six acute hospitals in the UK. Participants Patients attending with acute chest pain due to suspected myocardial infarction (N¼2243).Interventions Diagnostic assessment using a point-ofcare biomarker panel consisting of creatine kinase, myocardial type, myoglobin and troponin I measured at baseline and 90 min compared with standard care without the point-of-care panel.

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“…cTnI contributed significantly to the prognostic power of another scoring system for dogs with severe systemic diseases, the physiologic and laboratory evaluation (APPLE) full score in those patients 38. Using immunoassays with high sensitivity for cTnI improved the sensitivity for detection of myocardial injury as compared to older generation cTnI assays 7, 39, 40, 41…”

mentioning

confidence: 99%

Serum Cardiac Troponin I Concentrations in Dogs with Systemic Inflammatory Response Syndrome

Hamacher¹,

Dörfelt²,

Müller³

et al. 2015

Veterinary Internal Medicne

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BackgroundMyocardial injury can be detected by cardiac troponin I (cTnI) concentration, which appears to be a predictor of short‐term death in critically ill patients. It is unknown if the best prognostic indicator of short‐term survival is cTnI measurement at admission or at later time points.Hypothesis/ObjectivesMeasuring cTnI with a high‐sensitivity (HS) test at different time points after admission may be a better short‐term prognostic indicator than a single cTnI measurement at admission in dogs with systemic inflammatory response syndrome (SIRS).AnimalsProspective, observational clinical study of 60 dogs with SIRS.MethodsCardiac troponin I concentration was measured in 133 serum samples, collected at days 1, 2, 3, and 5. Additionally, the acute patient physiologic and laboratory evaluation (APPLE) fast score was evaluated at admission. Prognostic capabilities of cTnI measurement and APPLE fast score for 28‐day mortality were assessed by receiver operating characteristic curve analysis.ResultsForty‐one dogs with SIRS that survived 28 days had significantly lower serum cTnI concentrations at admission (median, 0.09 ng/mL; P = .004) and at the peak time point (median, 0.23 ng/mL; P = .01) compared to 19 nonsurvivors (median at admission, 0.63 ng/mL; median at peak, 1.22 ng/mL). Area under the curve to predict survival, using cTnI was similar at admission (0.732) and at peak (0.708), and was 0.754 for the APPLE fast score.Conclusions and Clinical ImportanceIncreased cTnI concentration in dogs with SIRS is associated with poor outcome. Daily follow‐up measurement of cTnI concentration provides no additional prognostic information for short‐term mortality.

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Bedside Multimarker Testing for Risk Stratification in Chest Pain Units

Cited by 232 publications

References 23 publications

Role of α-actin in muscle damage of injured athletes in comparison with traditional markers

Role of α-actin in muscle damage of injured athletes in comparison with traditional markers

The Randomised Assessment of Treatment using Panel Assay of Cardiac Markers (RATPAC) trial: a randomised controlled trial of point-of-care cardiac markers in the emergency department

Serum Cardiac Troponin I Concentrations in Dogs with Systemic Inflammatory Response Syndrome

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