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

Comparison of hs-cTnI, hs-cTnT, hFABP and GPBB for identifying early adverse cardiac events in patients presenting within six hours of chest pain-onset

“…The study population has been previously described [5] as well as the performance by the area under the curve (AUC) of hs-cTnI (AUC = 0.86) and hs-cTnT (AUC = 0.82) assays using the presentation sample for predicting a short-term adverse cardiac event [6]. Briefly, the inclusion criteria in the study were as follows: i) ≥18 years of age, ii) patients with possible ACS symptoms within 6 h before presentation, and iii) a cTnI ordered by an ED physician.…”

“…On the other hand, patients were excluded if: i) they refused to participate, ii) were referred directly to trauma/surgery, or iii) had an outcome before the initial cTnI result. The study outcomes (composite adverse cardiac events within 72 h after presentation) were: MI, heart failure, serious arrhythmia, refractory ischemic cardiac pain, or death [5,6]. After obtaining research ethics board approval, available serum samples collected at presentation and 3 h and 6 h later in the ED were thawed and analyzed for hs-cTnT (Roche Elecsys 2010) and hs-cTnI (investigational-use only assay; Beckman Coulter Access II) (first thaw) and levels of hFABP and GPBB (second thaw) were measured (Randox Evidence Investigator).…”

Emerging families of biomarkers for coronary artery disease: inflammatory mediators

“…The area under the curve values were significantly higher for the high-sensitivity cardiac TnI test, the AccuTnI assay, and the hs-cTnT test than for the other six tests. The ideal cutoffs for predicting serious cardiac outcomes in this high-risk population differed from the published 99th percentiles 100. Therefore, larger studies are needed to confirm the findings of this investigation.…”

An approach to rule-out an acute cardiovascular event or death in emergency department patients using outcome-based cutoffs for high-sensitivity cardiac troponin assays and glucose

“…Briefly, the LoD for these assays is as follows: Abbott hs-cTnI; LoD = 1 ng/L, Beckman hs-cTnI LoD = 3 ng/L, Roche hs-cTnT LoD = 5 ng/L with the precision for these assays during this study listed as follows: cohort 1, CV = 4.8% for the Abbott hs-cTnI patient QC pool (n = 147; mean = 43.2 ng/L) at the Juravinski Hospital ci8200 analyzer; 5.4% (n = 103; mean = 40.8 ng/L) at the Hamilton General Hospital ci16200#1 analyzer; and 4.7% (n = 117; mean = 41.0 ng/L) at the Hamilton General Hospital ci16200#2 analyzer; with cohort 2 and 3 analyses being performed on research designated analyzers also using low concentration patient pool material to determine the imprecision (CV = 15% at 5.8 ng/L for the Abbott hs-cTnI assay (i1000; n = 43)), CV = 9.6% at 13.7 ng/L for the Beckman Coulter research hs-cTnI assay (Access 2; n = 17) and CV = 14% at 12.5 ng/L for the Roche hs-cTnT assay (Elecsys 2010; n = 19) [22][23][24].…”

“…Samples for the Beckman hs-cTnI and Roche hs-cTnT measurements underwent one freeze-thaw cycle (storage at −70°C) with the Abbott hs-cTnI measurements performed on samples that underwent a second freeze-thaw cycle. All patients were adjudicated for the composite outcome (death, MI, heart failure, serious arrhythmia, refractory ischemic cardiac pain) at 72 h [22,28] (see Fig. 1).…”