Lower diagnostic accuracy of hs-cTnI in patients with prior coronary artery bypass grafting

Koechlin, Luca; Boeddinghaus, Jasper; Nestelberger, Thomas; López-Ayala, Pedro; Shrestha, Samyut; Wussler, Desiree; Haeni, N.; Walter, Joan; Twerenbold, Raphael; Eckstein, Friedrich S.; Reuthebuch, Oliver; McCord, James; Nowak, Richard M.; Christenson, Robert H.; DeFilippi, Chistopher R; Apple, Fred S.; Mueller, Christian

doi:10.1016/j.ijcard.2022.02.025

Cited by 4 publications

(1 citation statement)

References 21 publications

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“…48 A study published very recently tested the efficacy of the ESC 0/1 h algorithm in patients with prior coronary bypass and identified a good sensitivity/specificity or the rule-in/rule-out protocols (100% and 93.5%), but with lower efficacy in this study population compared to the general population (52% vs. 74%, p <0.01). 49 A study published by Ticinesi et al investigated the role of hs-cTn increase in elderly population presenting to the ED for chest pain and suspected AMI. It should be remembered that old patients are usually frail and frequently present elevated levels of hs-cTnI, which makes it difficult to interpret an elevated hs-cTnI in the ED in this group of patients.…”

Section: Cardiac Troponin and Comorbiditiesmentioning

confidence: 99%

Cardiac Biomarkers in 2022 – a Vital Tool for Emergency Care

Benedek

Marton-Popovici

2022

Journal of Cardiovascular Emergencies

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The role of cardiac biomarkers in diagnosing acute myocardial infarction is undoubted. In the 2020 guidelines of the European Society of Cardiology, the measurement of cardiac peptides to gain prognostic information has a class IIa indication in all patients with ACS. In emergency care, ruling out a non-ST elevation myocardial infarction requires documentation of normal levels of cardiac biomarkers, which remain stable or have very small variations within several hours. This review aims to summarize the current knowledge and recent progresses in the field of cardiac biomarker discovery, from their routine use in emergency rooms to their prognostic roles in modern risk assessment tools. Integrated approaches combining cardiac troponin with other biomarkers of ventricular dysfunction or inflammation, or with modern cardiac imaging in emergency care are also presented, as well as the role of modern algorithms for serial troponin measurement in the modern management of emergency departments.

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Section: Cardiac Troponin and Comorbiditiesmentioning

confidence: 99%

Cardiac Biomarkers in 2022 – a Vital Tool for Emergency Care

Benedek

Marton-Popovici

2022

Journal of Cardiovascular Emergencies

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Can a new biomarker complement the current diagnostic gap in the management of patients with suspected acute coronary syndrome?

Tanaka,

Ishii

2023

International Journal of Cardiology

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Comparing the utility of clinical risk scores and integrated clinical judgement in patients with suspected acute coronary syndrome

Meier,

Boeddinghaus,

Nestelberger

et al. 2023

European Heart Journal: Acute Cardiovascular Care

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Background The utility of clinical risk scores regarding prediction of major adverse cardiac events (MACE) is uncertain. We aimed to directly compare the prognostic performance of five established clinical risk scores as well as an unstructured integrated clinical judgment (ICJ) of the treating emergency department (ED) physician. Methods Thirty-day MACE including all-cause death, life-threatening arrhythmia, cardiogenic shock, acute myocardial infarction (including the index event), and unstable angina requiring urgent coronary revascularization were centrally adjudicated by two independent cardiologists in patients presenting to the ED with acute chest discomfort in an international multicenter study. We compared the prognostic performance of the HEART-score, GRACE-score, T-MACS, TIMI-score, and EDACS, as well as unstructured integrated clinical judgment (ICJ) of the treating ED physician (visual analogue scale to estimate the probability of an acute coronary syndrome (ACS), ranging from 0-100). Results Among 4551 eligible patients, 1110/4551 patients (24.4%) had at least one MACE within 30 days. Prognostic accuracy was high and comparable for the HEART-score, GRACE-score, T-MACS, and ICJ (area under the curve (AUC) 0.85-0.87), but significantly lower and only moderate for the TIMI-score (AUC 0.79, p<0.001) and EDACS (AUC 0.74, p<0.001), resulting in sensitivities for the rule-out of 30-day MACE of 93-96%, 87% (p<0.001), and 72% (p<0.001), respectively. Conclusion The HEART-score, GRACE-score, T-MACS, and unstructured ICJ of the treating physician, but not the TIMI-score or EDACS, performed well for the prediction of 30-day MACE and may be considered for routine clinical use.

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Lower diagnostic accuracy of hs-cTnI in patients with prior coronary artery bypass grafting

Cited by 4 publications

References 21 publications

Cardiac Biomarkers in 2022 – a Vital Tool for Emergency Care

Cardiac Biomarkers in 2022 – a Vital Tool for Emergency Care

Can a new biomarker complement the current diagnostic gap in the management of patients with suspected acute coronary syndrome?

Comparing the utility of clinical risk scores and integrated clinical judgement in patients with suspected acute coronary syndrome

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