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Risk prediction in chest pain patients by biochemical markers including estimates of renal function
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. (UCR)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. (UCR)
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2008 (English)In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 128, no 2, 207-213 p.Article in journal (Refereed) Published
Abstract [en]

Background: Early risk stratification of patients with chest pain may be improved by combining cardiac Troponin I (cTnI) results and ECG findings with markers of left-ventricular dysfunction, inflammation or renal function. Methods: Serial measurements of cTnI were prospectively performed in 452 chest pain patients with a non-diagnostic ECG for AMI and admitted to the coronary care unit. NT-pro BNP, CRP, cystatin C and creatinine-clearance were retrospectively analyzed in admission samples. The prognostic value of these markers alone and in different combinations together with ECG findings was evaluated by multivariate logistic regression models. Results: During follow-up, 14 deaths and 21 myocardial (re)-infarctions occurred. Independent predictors for the combined endpoint of death or (re)-infarction were peak cTnI ≥0.1 μg/L within 24 h (OR 3.9; 95% confidence interval [CI]1.5-10.4), cystatin C ≥1.28 mg/L (OR 5.6; 95% CI 1.9-16.3) and NT-pro BNP ≥550 ng/L (OR 2.7; 95% CI 1.0-7.3). At 2 h from admission, a combination of cTnI ≥0.1 μg/L, an abnormal ECG and NT-pro BNP or cystatin C as a third variable resulted in a similar stratification of patients to different risk groups. Conclusion: cTnI, NT-pro BNP and cystatin C are strong risk predictors in patients with chest pain. For pragmatic reasons, a combination of cTnI ≥0.1 μg/L, ECG findings and a marker of renal function, preferably cystatin C, appears to be most appropriate for early risk stratification of these patients.

Place, publisher, year, edition, pages
2008. Vol. 128, no 2, 207-213 p.
Keyword [en]
Chest pain, Risk stratification, Troponin, Cystatin C
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-96037DOI: 10.1016/j.ijcard.2007.04.096ISI: 000257950500010OAI: oai:DiVA.org:uu-96037DiVA: diva2:170453
Available from: 2007-05-30 Created: 2007-05-30 Last updated: 2017-12-14Bibliographically approved
In thesis
1. Cardiac Troponins in Patients with Suspected or Confirmed Acute Coronary Syndrome: New Applications for Biomarkers in Coronary Artery Disease
Open this publication in new window or tab >>Cardiac Troponins in Patients with Suspected or Confirmed Acute Coronary Syndrome: New Applications for Biomarkers in Coronary Artery Disease
2007 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The cardiac troponins are the biochemical markers of choice for the diagnosis of acute myocardial infarction (AMI) and risk prediction in patients with acute coronary syndrome (ACS). In this thesis, the role of early serial cardiac troponin I (cTnI) testing was assessed in fairly unselected patient populations admitted because of chest pain and participating in the FAST II-study (n=197) and the FASTER I-study (n=380). Additionally, the importance of cTnI testing in stable post-ACS patients from the FRISC II-study (n=1092) was studied.

The analyses in chest pain patients demonstrate that cTnI is very useful for early diagnostic and prognostic assessment. cTnI allowed already 2 hours after admission the reliable exclusion of AMI and the identification of low-risk patients when ECG findings and a renal marker such as cystatin C were added as conjuncts. Other biomarkers such as CK-MB, myoglobin, NT-pro BNP or CRP did not provide superior clinical information. However, myoglobin may be valuable in combination with cTnI results for the early prediction of an impending major AMI when used as input variable for an artificial neural network. Such an approach applying cTnI results only may also furthermore improve the early diagnosis of AMI.

Persistent cTnI elevation > 0.01 μg/L was detectable using a high-sensitive assay in 26% of the stable post-ACS patients from the FRISC II-study. NT-pro BNP levels at 6 months were the most important variable independently associated to persistent cTnI elevation besides male gender, indicating a relationship between adverse left ventricular remodeling processes and cTnI leakage. Patients with persistent cTnI elevation had a considerable risk for both mortality and AMI during 5 year follow-up.

These analyses thus, confirm the value of cTnI for early assessment of chest pain patients and provide new and unique evidence regarding the role of cTnI for risk prediction in post-ACS populations.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2007. 73 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 269
Keyword
Internal medicine, Ischemic heart disease, Acute myocardial infarction, Troponin, Natriuretic peptide, CRP, Cystatin C, Artificial neural network, Point of care measurements, Risk prediction, Invärtesmedicin
Identifiers
urn:nbn:se:uu:diva-7945 (URN)978-91-554-6924-5 (ISBN)
Public defence
2007-09-14, Robergsalen, Ingång 40, Akademiska Sjukhuset, Uppsala, 09:15
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Available from: 2007-05-30 Created: 2007-05-30 Last updated: 2011-01-19Bibliographically approved

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Eggers, KaiOldgren, JonasLindahl, Bertil

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