High-sensitivity cardiac troponin T for diagnosis of NSTEMI in the elderly emergency department patient: a clinical cohort study

Purpose: The aim of this study is to evaluate the impact of age on the diagnostic performance of high-sensitivity troponin T (hsTnT) under routine conditions.

Materials and methods: Data of 4118 consecutive emergency department (ED) patients who underwent a routine TnT measurement between 11 October 2012 and 30 November 2013 were analysed. Diagnostic accuracy of hsTnT was compared in four age categories (<50, 50–64, 65–74, ≥75 years of age) for different cut-off values. Primary endpoint was a main hospital diagnosis of NSTEMI.

Results: The median age of the study population (n?=?4118) was 61 years (IQR: 45–75 years). NSTEMI was diagnosed in 3.3% (n?=?136) of all patients. There were significant differences in hsTnT concentrations between age-groups (p?p?=?0.297). 72.2% of all patients ≥75 years of age (583/808) without NSTEMI had hsTnT concentrations above the 99th percentile of a healthy reference population. Specificity at 14?ng/L was 93.6% (95% CI: 92.12–94.87) in patients below 50 years of age and 27.9% (95% CI: 24.78–31.08) in patients 75 years of age and older.

Conclusions: Patients’ age needs to be considered at least one influencing factor on hsTnT concentrations at admission and should be included in the clinical interpretation of hsTnT concentrations for further clinical workup beneath other influencing factors like comorbidities and symptom onset time. The implementation of age-specific cut-off values could be considered for single troponin testing at admission but is associated with an increased risk of underdiagnosis of NSTEMI.     

Conventional and novel diagnostic biomarkers of acute myocardial infarction: a promising role for circulating microRNAs

Abstract

Biomarkers play a critical role in the diagnosis of acute myocardial infarction (AMI), especially in patients with atypical clinical and/or electrocardiographic presentation or co-morbidities, like the elderly. High-sensitivity assays based on specific biomarkers (e.g. cardiac troponins) enabling earlier AMI diagnosis have recently become available in clinical practice. Although no single biomarker of myocardial necrosis is ever likely to afford AMI diagnosis, a combination including different biomarkers for necrosis and ischemia, like new circulating molecules (microRNAs), could enhance diagnostic specificity. We review the recent literature on conventional and novel AMI biomarkers, with special emphasis on circulating microRNAs.     

高敏肌钙蛋白预测急性冠脉综合征的价值分析

目的:研究早期检测高敏肌钙蛋白对预测及诊断急性冠脉综合征的价值。方法:以2012年1月至2014年07月于我院就诊的82例疑似急性冠脉综合征患者为研究对象,采集血液标本,均分为两组,一组行血清常规肌钙蛋白T(c Tn T)检测,结果归入对照组;一组行血清高敏肌钙蛋白(hs-c Tn I)检测,结果归入观察组。同时行心肌酶谱及心电图检查,以其动态演变为金标准,评价两组敏感度、特异度,绘制ROC曲线。结果:金标准提示共64例阳性患者。观察组检测hs-c Tn I阳性62例,敏感度92.2%(59/64),特异度88.9%(16/18);对照组检查c Tn T阳性59例,敏感度79.7%(51/64),特异度55.6%(10/18),观察组ROC曲线优于对照组(P=0.000)。健康人群肌钙蛋白含量显著性低于急性冠脉综合征患者,差异具备统计学意义(P0.05)。结论:hs-c Tn I检测有助于预测急性冠脉综合征,其诊断敏感度及特异度均较高,可满足现阶段诊治需求。     

Prognostic implications of changes in cardiac troponin I levels in patients with non-ST elevation acute coronary syndrome

Abstract

Objective: Information is limited on the prognostic implications of cardiac troponin I (cTnI) changes during the first days of non-ST elevation acute coronary syndrome (NSTE-ACS).

Methods: High-sensitivity cTnI levels were measured at study inclusion and after 48?h in 1615 conservatively managed NSTE-ACS patients from the Global Use of Strategies To Open Occluded Coronary Arteries (GUSTO) IV trial.

Results: Patients with moderately increased cTnI levels and without a relevant decrease over time had a significantly raised mortality at 30 days and 1 year. No relevant associations between cTnI changes and recurrent myocardial infarction were seen.

Conclusion: The cTnI change is predictive for subsequent mortality in selected conservatively managed NSTE-ACS patients.     

Short-term effects of air pollution,markers of endothelial activation,and coagulation to predict major adverse cardiovascular events in patients with acute coronary syndrome: insights from AIRACOS study

The aim of this study was to determine whether markers of inflammation and coagulation are associated with short-term particulate matter exposure and predict major adverse cardiovascular events at 360 d in patients with acute coronary syndrome (ACS). We included 307 consecutive patients, and assessed the average concentrations of data on atmospheric pollution in ambient air and meteorological variables from 1?d up to 7 d prior to admission. In patients with ACS, the markers of endothelial activation and coagulation, but not black carbon exposure, are associated with major adverse cardiovascular events at one-year follow-up.     

Identification of acute myocardial infarction in elderly patients using optimized highly sensitive troponin I thresholds

Purpose: Established diagnostic thresholds for high-sensitivity cardiac troponins (hs-cTn) might not apply for elderly patients as they are elevated irrespective of the presence of an acute myocardial infarction (AMI). Aim of the present study was to investigate hs-cTnI in elderly patients with suspected AMI and to calculate optimized diagnostic cutoffs.

Material and methods: Data from a prospective multi-centre study and from a second independent prospective single-centre cohort study were analysed. A number of 2903 patients were eligible for further analysis. Patients > 70 years were classified as elderly. hs-cTnI was measured upon admission.

Results: Around 34.7% of 2903 patients were classified as elderly. Around 22.5% of elderly patients were finally diagnosed with AMI. Elderly patients had higher hs-cTnI levels at admission irrespective of the final diagnosis (p?<?0.001). According to the AUROC, hs-cTnI was a strong marker for detection of AMI in elderly patients. Application of the 99th percentile cutoffs showed a substantially lower specificity in elderly. By using optimized thresholds, specificity was improved to levels as in younger patients in both cohorts but accompanied with a decrease in sensitivity.

Conclusions: hs-cTnI levels have a lower specificity for detecting AMI in elderly patients. This lower specificity can be improved by using hs-cTnI thresholds optimized for elderly patients.     

血清标志物联合检测在急性冠状动脉综合征诊断中的应用

目的:探讨血清cTnⅠ、CK-MB、MYO及BNP联合检测在急性冠状动脉综合征诊断中的临床价值。方法:选择临床及冠状动脉造影明确诊断的ACS患者76例,稳定性心绞痛患者32例,同期选择35例健康体检者作实验对照组;应用免疫化学发光法分别检测患者血清中cTnⅠ、CK-MB、MYO及BNP水平,采用受试者工作特征曲线(ROC)评价各指标的敏感度、特异度,并分析4项指标联合检测的诊断价值。结果:ACS组血清cTnⅠ、CK-MB、MYO及BNP水平分别为(9.27±7.25)μg/L、(239.50±213.27)ng/ml、(37.06±21.60)ng/ml、(632.11±293.20)pg/ml;AS组分别为(1.32±0.57)μg/L、(63.34±31.02)ng/ml、(19.48±8.04)ng/ml、(125.20±6.57)pg/ml;对照组为(0.17±0.06)μg/L、(30.02±15.23)ng/ml、(14.06±3.19)ng/ml、(47.52±21.30)pg/ml;ACS组患者血清cTnⅠ、CK-MB、MYO及BNP水平及阳性率均高于SA组和健康对照组,组间差异有统计学意义(P0.05);cTnⅠ的ROC曲线下面积(AUC)为(0.917±0.025),高于BNP曲线下面积(0.823±0.031)(P=0.037);4项指标联合检测ACS患者的敏感度(92.3%),高于单项检测86.0%(P0.05)。结论:检测血清cTnⅠ、CK-MB、MYO及BNP对于判定心肌缺血和损伤程度有重要价值,各项指标之间有互补作用,联合检测可为ACS早期诊断提供参考依据。     

Comparison of temporal changes in established cardiovascular biomarkers after acute coronary syndrome between Caucasian and Chinese patients with diabetes mellitus

Abstract

Background: Population means of conventional cardiovascular biomarkers are known to differ between ethnic groups. In this study we performed detailed comparisons in the temporal pattern of these biomarkers between Caucasian and Chinese diabetic patients with acute coronary syndrome (ACS).

Methods: We studied differences in temporal changes of established cardiovascular biomarkers, including high-density lipoprotein (HDL), low-density lipoprotein (LDL), total cholesterol, cardiac Troponin T (TnT), NT-proBNP and C-reactive protein (CRP), in 48 Chinese and 48 clinically matched Caucasian patients with type 2 diabetes mellitus who were admitted for ACS. Blood samples were collected at regular time intervals during 30?days to 1?year after the index ACS.

Results: In the >30?day post ACS period, mean serum levels of LDL (2.16 vs. 1.47?mmol/L; p-value <0.001), total cholesterol (4.08 vs. 3.11?mmol/L; p-value <0.001), TnT (11.0 vs. 7.76?ng/L; p-value 0.010) and CRP (2.0 vs. 0.78?mg/L; p-value <0.001) were systematically higher in Caucasian than in Chinese patients. HDL and NT-proBNP levels were similar.

Conclusions: Our study showed clinically relevant differences in levels of established cardiovascular biomarkers between Caucasian and Chinese post ACS patients. Further cross-ethnic studies are warranted to determine secondary prevention treatment biomarker targets in specific populations.     

Finding biomarkers for non-small cell lung cancer diagnosis and prognosis

Despite of several decades of efforts,lung cancer remains one of most deadly diseases,with a 5-year survival rate approximately 15％ worldwide.In China,the situation is even worse.Although there is no o...     

替格瑞洛在急性冠脉综合征患者经皮冠状动脉介入治疗术后的应用价值

目的:评价替格瑞洛在急性冠脉综合征(acute coronary syndrome,ACS)患者经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术后的应用价值。方法:将我院收治的565例成功行PCI的急性冠脉综合征(acute coronary syndrome,ACS)患者随机分为2组:氯吡格雷组253例,术后口服氯吡格雷75 mg、QD;替格瑞洛组312例,术后口服替格瑞洛首剂180 mg,维持量90mg、BID。两组患者术后常规口服阿司匹林100 mg、QD。研究主要终点为主要不良心血管事件(major adverse cardiovascular events,MACE),包括全因死亡、靶血管血运重建和脑梗塞;次要终点为TIMI主要出血(定义为血红蛋白下降50 g/L或颅内出血有关的临床显著出血事件)。结果:565例患者平均随访12个月,替格瑞洛组MACE发生率低于氯吡格雷组(3.8%vs.8.7%,P0.05),两组TIMI主要出血事件发生率比较,差异无统计学意义(2.9%vs.3.2%,P0.05)。结论:替格瑞洛能明显减少PCI术后主要不良心血管事件,并不增加主要出血。     

The real-life value of ST2 monitoring during heart failure decompensation: impact on long-term readmission and mortality

Context: Prognostic value of ST2 levels and dynamics has not been investigated in acute heart failure (AHF) using prospective real-life measurements.

Objective: The objective of this study is to investigate the prognostic value of ST2 in AHF.

Methods: ST2 levels were determined at admission (n?=?182) and discharge (n?=?85). Primary endpoint was the composite of all-cause death and HF rehospitalisation at one year.

Results: Discharge ST2 (HR 2.42 [95% CI 1.46–4], p?=?0.001) and ΔST2 (HR 2.32 [95% CI 1.21–4.57], p?=?0.01) but not admission ST2, remained independently prognostic for the primary endpoint after comprehensive multivariable adjustment. ST2 significantly improved prognosis stratification on top of clinical variables and NTproBNP.

Conclusions: Routine clinical use of discharge ST2 and ST2 dynamics provide independent prognostic information.     

Current discharge management of acute coronary syndromes: data from the Rijnmond Collective Cardiology Research (CCR) study

Background

Medical discharge management of acute coronary syndromes (ACS) remains suboptimal outside randomised trials and constitutes an essential quality benchmark for ACS. We sought to evaluate the rates of key guideline-recommended pharmacological agents after ACS and characteristics associated with optimal treatment at discharge.

Methods

The Rijnmond Collective Cardiology Research (CCR) registry is an ongoing prospective, observational study in the Netherlands that aims to enrol 4000 patients with ACS. We examined discharge and 1-month follow-up medication use among the first 1000 patients enrolled in the CCR registry. Logistic regression was performed to identify patient and hospital characteristics associated with collective guideline-recommended pharmacotherapy at hospital discharge.

Results

At discharge, 94 % of patients received aspirin, 100 % thienopyridines, 80 % angiotensin-converting enzyme inhibitors/angiotensin-II receptor blockers, 87 % β-blockers, 96 % statins, and 65 % the combination of all 5 agents. ST-segment elevation myocardial infarction, hypertension, hypercholesterolaemia, and enrolment in an interventional centre were positive independent predictors of 5-drug combination therapy at discharge. Negative independent predictors were unstable angina and advanced age.

Conclusion

Current data from the CCR registry reflect a high quality of care for ACS discharge management in the Rotterdam-Rijnmond region. However, potential still remains for further optimisation.     

阿托伐他汀钙片治疗急性冠脉综合征的临床疗效

目的:探讨阿托伐他片汀治疗急性冠脉综合征(ACS)的临床疗效。方法:选择2013年3月至2013年12月我院收治的156例ACS患者,按随机字数表法分为实验组和对照组各78例,两组均采取常规治疗,实验组在此基础上加用阿托伐他汀钙片,对照组则用辛伐他汀滴丸。对比两组治疗效果及心血管事件发生率。结果:两组治疗后总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、血清高敏C反应蛋白(hs-CRP)、纤维蛋白原(Fg)和尿酸水平均明显下降,且实验组下降更明显,比较差异均有统计学意义(P0.05);治疗期间实验组心血管事件发生率率为8.97%(7/78),显著低于对照组的24.36%(19/78),比较差异均有统计学意义(P0.05)。结论:阿托伐他汀片治疗ACS的临床效果优于辛伐他汀滴丸,能有效降低心血管事件的发生,值得的临床推广。     

Release kinetics of high-sensitivity cardiac troponins I and T and troponin T upstream open reading frame peptide (TnTuORF) in clinically induced acute myocardial infarction

Context: Troponin T upstream open reading frame peptide (TnTuORF) may be useful as a novel biomarker in acute cardiac syndromes.

Objective: The study examined the early release kinetics of TnTuORF.

Materials and methods: We analyzed the time course of the release of cardiac troponins I and T and TnTuORF in patients (n?=?31) with hypertrophic obstructive cardiomyopathy undergoing transcoronary ablation of septal hypertrophy (TASH).

Results: Fifteen minutes after TASH, the levels of both troponins increased significantly (cTnT median: 18?ng/L versus 27?ng/L; cTnI median: 15?ng/L versus 25?ng/L). TnTuORF showed no variation.

Discussion: We observed a significantly greater increase in cTnI compared with cTnT.

Conclusion: Our results demonstrate that troponin assays allow early detection of myocardial injury, whereas TnTuORF levels remain unchanged in this setting.