Abstract
The Use of Biochip Cardiac Array Technology for Early Diagnosis of Acute Coronary SyndromesSerum 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 >99thpercentile for the reference population in 83.3% of subjects, but none reached the cut-off 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 of myocardial injury in clinical practice.
Highlights
Diagnosis of acute myocardial infarction in the emergency department, according to the recommendations published in 2007, is based on the increase of cardiac troponin above the 99th percentile reference value for healthy population, in patients with evidence of myocardial ischemia [1]
Multimarker strategy seems to be more sensitive for myocardial infarction and acute coronary syndrome (ACS) detection than cardiac troponin alone unless highly sensitive cTn assay is used and a concentration of this biomarker over the 99th percentile is accepted as indicative of ACS
The median values of cTnI and myoglobin measured on admission (≤6 hrs) were significantly higher in three vessel disease than in one vessel disease group (p
Summary
Diagnosis of acute myocardial infarction in the emergency department, according to the recommendations published in 2007, is based on the increase of cardiac troponin above the 99th percentile reference value for healthy population, in patients with evidence of myocardial ischemia [1]. The prolonged release pattern of cTn and sensitivity of the assay makes it difficult to diagnose ACS early, adding of markers increasing rapidly after the symptoms, improves the identification of patients for more aggressive interventions. Multimarker strategy seems to be more sensitive for myocardial infarction and ACS detection than cardiac troponin alone unless highly sensitive cTn assay is used and a concentration of this biomarker over the 99th percentile is accepted as indicative of ACS
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