The Use of Biochip Cardiac Array Technology for Early Diagnosis of Acute Coronary Syndromes

Abstract

Kratak sadr`aj: Troponin u serumu je najbolji biomarker za dijagnostikovanje akutnog koronarnog sindroma, ali do postavljanja definitivne dijagnoze prolazi dosta vremena. Cilj studije je da se ispita da li pristup s vi{e markera, pomo }u bio~ip metode omogu}ava rano dijgnostikovanje. Bio markeri u serumu odre|eni su prilikom prijema (≤6 asova) i posle 6 ~asova kod 42 pacijenata sa simptomima akutnog koronarnog sindroma. Sr~ani troponin I izmeren je osetljivim testom (STATcTnI) dok su sr~ani markeri (H-FABP, mioglobin, cTnI, maseni CK-MB, karbo-anhi draza III) odre|eni pomo}u tehnologije »Biochip Array«. Koncen tracije dobijene pomo}u STATcTnI u prvih 6 ~asova bile su povi{ene >99 procenata u odnosu na referentnu populaciju kod 83,3% ispitanika, ali ni kod koga nisu pre{le »cut-off« vrednost za akutni infarkt miokarda. Prilikom prijema samo je marker H-FABP imao senzitivnost od 90,5% u svim slu~ajevima akutnih koronarnih sindroma i senzitivnost od 100% kod pacijenata sa STEMI/NSTEMI. Osetljivost mio globina na prijemu bila je 71,4% za AKS, me|utim, osetljivost kombinacije mioglobina i H-FABP dostigla je 95,2%. Sni`avanje »cut-off« vrednosti za cTnI omogu}ilo je rano dijagnostikovanje (≤6 ~asova) kod samo 26,2% pacijenata sa AKS i 95,2% posle slede}ih 6 ~asova. Kod nestabilne angine sr~ani panel nije bio dovoljno pre cizan za ranu stra tifikaciju rizika. Mo`e se zaklju~iti da testiranje oba markera -H-FABP i senzitivnog sr~anog tropo nina do stupno putem metode »Cardiac Array« -mo`e olak{ati ranu detekciju o{te}enja miokarda u klini~koj praksi.Klju~ne re~i: akutni koronarni sindromi, sr~ani biomarkeri, troponin, H-FABP Summary: Serum troponin is the best biomarker for the diagnosis of acute coronary syndrome, but it takes considerable time before a definitive diagnosis is available. The purpose of this study was to evaluate whether a multimarker approach, using the biochip cardiac array, would facilitate the early diagnosis. Serum biomarkers were determined on admission (≤6 hrs) and after 6 hours in 42 patients suspected for ACS. Cardiac troponin I was measured by a sensitive assay (STATcTnI) and cardiac markers (H-FABP, myoglobin, cTnI, CK-MB mass, carbonic anhydrase III) were assayed with the use of Biochip Array Technology. STATcTnI concentrations, within the first 6 hours, were elevated >99 th percentile for the reference population in 83.3% of subjects, but none reached the cutoff for AMI. On admission H-FABP was the only marker with 90.5% sensitivity in all ACS cases and 100% sensitivity in STEMI/NSTEMI patients. The sensitivity of myoglobin at presentation was 71.4% in ACS, however, combined sensitivity of myoglobin and H-FABP reached 95.2%. Lowering the cut-off for cTnI allowed early diagnosis (≤6 hrs) in only 26.2% of ACS patients and 95.2% after the next 6 hours. In unstable angina the cardiac panel was not sufficiently accurate for early risk stratification. In conclusion, testing for both markers, H-FABP and sensitive cardiac troponin, available with the cardiac array may facilitate the early detection...

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