Recent developments in diagnosis and risk stratification of non-ST-elevation acute coronary syndrome

Aarts, Goaris W A; Mol, Jan-Quinten; Camaro, Cyril; Lemkes, Jorrit S.; Royen, Niels van; Damman, Peter

doi:10.1007/s12471-020-01457-3

Cited by 7 publications

(6 citation statements)

References 35 publications

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“…Despite of continuing advances in the treatment of ACS, particularly of the revascularization therapy such as percutaneous coronary intervention (PCI), patients with ACS remain of poor prognosis [3,4]. Accordingly, identification of predictors for prognosis in ACS patients has becoming more and more important for improving the risk strati-fication of the patients and development of novel treatment strategies [5,6].…”

Section: Introductionmentioning

confidence: 99%

Triglyceride-Glucose Index Predicts Adverse Events in Patients with Acute Coronary Syndrome: A Meta-Analysis of Cohort Studies

Ren

Chang

et al. 2021

Horm Metab Res

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The triglyceride-glucose (TyG) index, a recently proposed indicator for insulin resistance, has been related with cardiovascular risks. We aimed to summarize the association between TyG index and incidence of major adverse cardiovascular events (MACEs) in patients with acute coronary syndrome (ACS). Cohort studies demonstrating the association between TyG index and incidence of MACEs in ACS patients with multivariate adjusted analyses were identified by search of PubMed, Embase, and Web of Science databases. A random-effekt model incorporating the heterogeneity was applied to pool the results. Eight cohort studies with 19 611 participants were included. Results showed that compared to those with the lowest category of TyG index, ACS patients with the highest category of TyG index were independently associated with higher risk of MACEs [risk ratio (RR): 1.94, 95% confidence interval (CI): 1.47–2.56, I2=85%, p <0.001). Subgroup analyses showed consistent results in patients with ST-segment elevated myocardial infarction or non-ST segment elevated ACS, in patients with or without diabetes, and in patients after percutaneous coronary intervention. Results were consistent in studies with TyG index analyzed as continuous variable (RR for per standard deviation increment of TyG index: 1.59, 95% CI: 1.38–1.83, I2=24%, p <0.001). In conclusion, higher TyG index may be independently associated with higher incidence of MACEs in patients with ACS.

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Section: Introductionmentioning

confidence: 99%

Triglyceride-Glucose Index Predicts Adverse Events in Patients with Acute Coronary Syndrome: A Meta-Analysis of Cohort Studies

Ren

Chang

et al. 2021

Horm Metab Res

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“…6 Early recognition of the latter two groups is essential to streamline appropriate and safe management, discharge, and follow-up pathways while avoiding unnecessary diagnostic and therapeutic delays. 7,8 While several risk-assessment tools have been developed for risk stratification of chest pain, few have been validated in the ED. 9 For this study, the HEART, GRACE and TIMI scores have been selected for comparison as they have been widely used, are easily applicable to the ED setting and are non-tedious.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Various Clinical Risk Assessment Tools in Predicting Major Adverse Cardiac Events in Patients Presenting in Emergency Department with Undifferentiated Cardiac Chest Pain

Bakhsh

Pervez

Ashraf

et al. 2023

PAFMJ

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Objective: To compare the “HEART (History, ECG, Age, Risk factors, Troponin), GRACE (Global Registry of Acute Coronary Events), and TIMI (Thrombolysis in Myocardial Infarction)” scores in predicting major adverse cardiac events (MACE) in patients reporting with undifferentiated cardiac chest pain to the Emergency Department (ED). Study Design: Cross-sectional validation study Duration and place of Study: Emergency Department, Combined Military Hospital, Rawalpindi Pakistan, from Jan to Jun 2021. Methodology: Two hundred and thirty-seven adult patients with atraumatic cardiac-like chest pain and non-diagnostic electrocardiogram (ECG) reporting to the ED were included in the study. HEART, GRACE and TIMI scores were calculated from the data. The number of patients with low risk was identified by each score and compared at a fixed safety level of minimum 95% sensitivity. The potential occurrence of MACE was confirmed using a telephonic follow-up six weeks after the presentation. Results: At an absolute safety level of minimum 95% sensitivity, the HEART score determined 101 patients as “low-risk” with 1.98% MACE missed. The GRACE score identified 49 “low-risk” patients with 4.08% MACE missed, and the TIMI score identified 66 “low-risk” patients with 3.03% MACE missed. Conclusion: Among the three scores under comparison, the HEART score performed better than the GRACE and TIMI scores at the same safety level and surpassed them in differentiating between those with MACE and without MACE.

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“…POC troponin testing might also play a substantial role in the triage and diagnosis of chest pain patients in a prehospital setting by integrating on-site POC troponin testing in validated risk stratification tools for ACS [9][10][11]. However, POC troponin testing typically involves venous whole blood as the measurement matrix and venous blood drawing might not be easily available in every primary care setting, especially at the GP offices [12,13]. The Atellica ® VTLi Patient-side Immunoassay Analyzer for high-sensitivity POC cardiac troponin-I (hs-cTnI) testing has been developed by Siemens Healthineers.…”

Section: Introductionmentioning

confidence: 99%

Point-of-care high-sensitivity troponin-I analysis in capillary blood for acute coronary syndrome diagnostics

Bruinen

Frenk

Theije

et al. 2022

Clinical Chemistry and Laboratory Medicine (CCLM)

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Objectives Patients with acute coronary syndrome (ACS) should be referred promptly to the hospital to reduce mortality and morbidity. Differentiating between low-risk and high-risk patients remains a diagnostic challenge. Point-of-care testing can contribute to earlier disposition decisions for patients excluded from ACS. This study describes the validation of the Atellica® VTLi. Patient-side Immunoassay Analyzer for high-sensitivity troponin point-of-care (POC) analysis. (The Atellica VTLi is not available for sale in the USA. The products/features (mentioned herein) are not commercially available in all countries. Their future availability cannot be guaranteed). Methods A total of 152 patients with acute chest pain admitted at the cardiac emergency department (ED) were included in the study. Capillary blood was compared with a whole blood and plasma sample obtained by venipuncture. All samples were analyzed using the Atellica VTLi Patient-side Immunoassay Analyzer; in addition, plasma was analyzed by a central lab immunoassay analyzer. Results No significant difference was observed between venous whole blood vs. plasma analyzed by the Atellica VTLi Patient-side Immunoassay Analyzer. The difference between capillary blood and venous blood showed a constant bias of 7.1%, for which a correction factor has been implemented. No clinically relevant differences were observed for the capillary POC results compared to plasma analyzed with a standard immunoassay analyzer. Conclusions The Atellica VTLi Patient-side Immunoassay Analyzer for high-sensitivity troponin analysis shows equivalent results for all sample types, including capillary blood. No clinically relevant discordances were observed between capillary POC and central laboratory results. With additional studies, this could pave the way towards rapid testing of high-sensitivity troponin in the ambulance or the general practitioner’s office without the need for hospitalization of patients with acute chest pain.

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Recent developments in diagnosis and risk stratification of non-ST-elevation acute coronary syndrome

Abstract: In the past year, a number of important papers have been published on non-ST-elevation acute coronary syndrome, highlighting progress in clinical care. The current review focuses on early diagnosis and risk stratification using biomarkers and advances in intracoronary imaging.

Cited by 7 publications

References 35 publications

Triglyceride-Glucose Index Predicts Adverse Events in Patients with Acute Coronary Syndrome: A Meta-Analysis of Cohort Studies

Triglyceride-Glucose Index Predicts Adverse Events in Patients with Acute Coronary Syndrome: A Meta-Analysis of Cohort Studies

Comparison of Various Clinical Risk Assessment Tools in Predicting Major Adverse Cardiac Events in Patients Presenting in Emergency Department with Undifferentiated Cardiac Chest Pain

Point-of-care high-sensitivity troponin-I analysis in capillary blood for acute coronary syndrome diagnostics

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