Diagnostic algorithms for non-ST-segment elevation myocardial infarction: open issues

Clerico, Aldo; Aimo, Alberto; Zaninotto, Martina; Plebani, Mario

doi:10.1515/cclm-2021-0550

Cited by 2 publications

(2 citation statements)

References 82 publications

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“…It seems much easier to estimate the variation in hs-cTnI and hs-cTnT concentrations as a percentage rather than as absolute changes as recommend by ESC guidelines, by measuring the relative change values (RCV) [48][49][50][51]. This practical approach is based on the evidence that the imprecision profiles of the hs-cTnI and hs-cTnT are not significantly different [18,40,[48][49][50][51][66][67][68][69]. Indeed, the RCV values for a series of two samples were reported to vary on average by 32%, in agreement with many experimental and clinical studies including both healthy adult subjects and patients admitted to the ED in whom the presence of acute heart damage was excluded [18,40,[48][49][50][51][65][66][67][68][69][70][71].…”

Section: Clinical Relevance Of the Biological Variation In Cardiac Bi...mentioning

confidence: 99%

“…This practical approach is based on the evidence that the imprecision profiles of the hs-cTnI and hs-cTnT are not significantly different [18,40,[48][49][50][51][66][67][68][69]. Indeed, the RCV values for a series of two samples were reported to vary on average by 32%, in agreement with many experimental and clinical studies including both healthy adult subjects and patients admitted to the ED in whom the presence of acute heart damage was excluded [18,40,[48][49][50][51][65][66][67][68][69][70][71]. The percent change rule (RCV%) for evaluating the kinetics of hs-cTnI and hs-cTnT values in patients admitted to the ED with suspected MI is recommended by many guidelines and expert papers [8,14,16,17,19,57].…”

Section: Clinical Relevance Of the Biological Variation In Cardiac Bi...mentioning

confidence: 99%

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Measurement of Cardiac-Specific Biomarkers in the Emergency Department: New Insight in Risk Evaluation

Aspromonte,

Zaninotto,

Aimo

et al. 2023

IJMS

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The aim of this article review is to analyze some models and clinical issues related to the implementation of accelerated diagnostic protocols based on specific cardiac biomarkers in patients admitted to the emergency department (ED) with symptoms compatible with acute cardiac disorders. Four specific clinical issues will be discussed in detail: (a) pathophysiological and clinical interpretations of circulating hs-cTnI and hs-cTnT levels; (b) the clinical relevance and estimation of the biological variation of biomarkers in patients admitted to the ED with acute and severe diseases; (c) the role and advantages of the point-of-care testing (POCT) methods for cardiac-specific biomarkers in pre-hospital and hospital clinical practice; and (d) the clinical role of specific cardiac biomarkers in patients with acute heart failure (AHF). In order to balance the risk between a hasty discharge versus the potential harms caused by a cardiac assessment in patients admitted to the ED with suspected acute cardiovascular disease, the measurement of specific cardiac biomarkers is essential for the early identification of the presence of myocardial dysfunction and/or injury and to significantly reduce the length and costs of hospitalization. Moreover, specific cardiac biomarkers (especially hs-cTnI and hs-cTnT) are useful predictors of mortality and major adverse cardiovascular events (MACE) in patients admitted to the ED with suspected acute cardiovascular disease. To guide the implementation of the most rapid algorithms for the diagnosis of Non-ST-Elevation Myocardial Infarction (NSTEMI) into routine clinical practice, clinical scientific societies and laboratory medicine societies should promote collaborative studies specifically designed for the evaluation of the analytical performance and, especially, the cost/benefit ratio resulting from the use of these clinical protocols and POCT methods in the ED clinical practice.

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Section: Clinical Relevance Of the Biological Variation In Cardiac Bi...mentioning

confidence: 99%

Section: Clinical Relevance Of the Biological Variation In Cardiac Bi...mentioning

confidence: 99%

Measurement of Cardiac-Specific Biomarkers in the Emergency Department: New Insight in Risk Evaluation

Aspromonte,

Zaninotto,

Aimo

et al. 2023

IJMS

Self Cite

View full text Add to dashboard Cite

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Variability of cardiac troponin levels in normal subjects and in patients with cardiovascular diseases: analytical considerations and clinical relevance

Clerico

Zaninotto

Aimo

et al. 2023

Clinical Chemistry and Laboratory Medicine (CCLM)

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In accordance with all the most recent international guidelines, the variation of circulating levels of cardiac troponins I and T, measured with high-sensitivity methods (hs-cTnI and hs-cTnT), should be used for the detection of acute myocardial injury. Recent experimental and clinical evidences have demonstrated that the evaluation of hs-cTnI and hs-cTnT variations is particularly relevant: a) for the differential diagnosis of Acute Coronary Syndromes (ACS) in patients admitted to the Emergency Department (ED); b) for the evaluation of cardiovascular risk in patients undergoing major cardiac or non-cardiac surgery, and in asymptomatic subjects of the general population aged >55 years and with co-morbidities; c) for the evaluation of cardiotoxicity caused by administration of some chemotherapy drugs in patients with malignant tumors. The aim of this document is to discuss the fundamental statistical and biological considerations on the intraindividual variability of hs-cTnI and hs-cTnT over time in the same individual. Firstly, it will be discussed in detail as the variations of circulating levels strictly depend not only on the analytical error of the method used but also on the intra-individual variability of the biomarker. Afterwards, the pathophysiological interpretation and the clinical relevance of the determination of the variability of the hs-cTnI and hs-cTnT values in patients with specific clinical conditions are discussed. Finally, the evaluation over time of the variation in circulating levels of hs-cTnI and hs-cTnT is proposed for a more accurate estimation of cardiovascular risk in asymptomatic subjects from the general population.

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Diagnostic algorithms for non-ST-segment elevation myocardial infarction: open issues

Cited by 2 publications

References 82 publications

Measurement of Cardiac-Specific Biomarkers in the Emergency Department: New Insight in Risk Evaluation

Measurement of Cardiac-Specific Biomarkers in the Emergency Department: New Insight in Risk Evaluation

Variability of cardiac troponin levels in normal subjects and in patients with cardiovascular diseases: analytical considerations and clinical relevance

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