Diagnosis Of Acute Coronary Syndrome Research Articles

A Feasibility Study for CODE-MI: High-Sensitivity Cardiac Troponin - Optimizing the Diagnosis of Acute Myocardial Infarction/Injury in Women.

ObjectivesThis feasibility study was conducted to inform the design and power evaluation of CODE-MI, a pan-Canadian trial evaluating the impact of using the female-specific 99th-percentile threshold for high-sensitivity cardiac troponin (hs-cTn) on the diagnosis, treatment and outcomes of women presenting to the emergency department with symptoms suggestive for myocardial ischemia. ApproachCODE-MI is a multi-center, stepped-wedge cluster randomized trial. The cohort and outcomes will be obtained from routinely collected administrative data. Using linked administrative data from 11 hospitals in Ontario from 2014/10 to 2017/09, this feasibility study obtained the following estimates: number of eligible patients, i.e., women presenting to the emergency department with symptoms suggestive of myocardial ischemia and a 24-hour peak hs-cTn value within the female-specific and overall thresholds (i.e. primary cohort); the rate of the 1-year composite outcome of all-cause mortality, re-admission for non-fatal myocardial infarction, incident heart failure, or emergent/urgent coronary revascularization. Study power was evaluated via simulations. ResultsOverall, 2,073,849 emergency department visits were assessed. Among women, chest pain (with or without cardiac features) and shortness of breath were the most common complaints associated with a diagnosis of acute coronary syndrome. An estimated 7.7% of women with these complaints are eligible for inclusion in the primary cohort. The rate of the 1-year outcome in the primary cohort varied significantly across hospitals with a median rate of 12.2% (95%CI: 7.9%-17.7%). With 30 hospitals, randomized at 5-month intervals in 5 steps, approximately 19,600 women are expected to be included in CODE-MI, resulting in >82% power to detect a 20% decrease in the odds of the primary outcome at a 0.05 significance level. ConclusionRoutinely collected administrative health data serve as a rich and essential resource for conducting pragmatic trials assessing process change, such as CODE-MI. We demonstrated the strength of using linked administrative health data to guide the design of pragmatic clinical trials and accurately evaluate the study power.

Investigation of the Associations of Novel Inflammatory Biomarkers-Systemic Inflammatory Index (SII) and Systemic Inflammatory Response Index (SIRI)-With the Severity of Coronary Artery Disease and Acute Coronary Syndrome Occurrence.

Atherosclerosis, the underlying cause of coronary artery disease (CAD), has a significant inflammatory component. White blood cell count is an affordable and accessible way to assess the systemic immune response, as it comprises many subgroups with distinct and complex functions. Considering their multidirectional effect on atherosclerosis, new biomarkers integrating various leukocyte subgroups, the Systemic Inflammatory Index (SII) and the Systemic Inflammatory Response Index (SIRI), were recently devised to describe the balance between inflammation and immune reaction. This research aimed to evaluate the relationship of the intensity of inflammation measured by these biomarkers with the severity of CAD assessed with coronary angiography and with the diagnosis of acute coronary syndrome (ACS) or stable CAD in 699 patients. SIRI, but not SII, was associated with the diagnosis, having the highest values for patients with ACS (STEMI), significantly higher than in patients with stable CAD (p < 0.01). The highest SII and SIRI values were observed in patients with three-vessel CAD. SII and SIRI require further in-depth and well-designed research to evaluate their potential in a clinical setting.

Antiplatelet Therapy during the First Year after Acute Coronary Syndrome in a Contemporary Italian Community of over 5 Million Subjects.

Background: Patterns of real-world antiplatelet therapy (APT) are reported to differ from guideline recommendations. This study describes patterns of APT during the year following a hospital diagnosis of acute coronary syndrome (ACS) and possible implications in terms of revascularization rates, rehospitalizations, and costs for the Italian National Health Service. Methods: From >5 million people, patients discharged (=index date) with primary/secondary ACS diagnosis in 2017 were identified by cross-linkage of administrative health data collected by the Ricerca e Salute (ReS) Foundation. Patients were characterized by revascularization rates at index date, APT at one month and one year (with appropriate coverage defined as ≥80% of defined daily doses), and rehospitalizations and healthcare costs during follow-up. Results: From the 2017 ReS database, 7966 (1.46 × 1000 inhabitants) were discharged alive with an ACS diagnosis. Most were >69 years and male. Of these, 83% (6640/7966) received ≥1 recommended antiplatelet agent within one month (treated group): 23% (1870/7966) as single and 60% (4770/7966) as dual APT. Among the 53% undergoing revascularization, 81% received dual APT at one month. Of the 78% with the same APT at one year, 66% showed appropriate coverage. For subjects treated and untreated with APT at one month, one-year rehospitalization rates were 54% and 66%, respectively, and mean per capita costs were EUR 14,316 and EUR 16,552, respectively (hospitalization driving >80% of costs). Conclusions: Among survivors of a hospitalized ACS diagnosis, this analysis shows relatively high APT under-treatment at one month and one year, associated with fewer index revascularization rates, more rehospitalizations, and greater costs. Further initiatives to understand undertreatment and poor adherence should lead to improved health management and savings.

Caractéristiques des douleurs thoraciques au cours des syndromes coronariens aigus vus au service de cardiologie de Befelatanana (Madagascar)

IntroductionChest pain is one of the different elements of orientation for the diagnosis of acute coronary syndrome. Sometimes its clinical presentation is misleading. The objective of this study was to describe the characteristics of chest pain during an acute coronary syndrome in the cardiology department of the Joseph Raseta Befelatanana University Hospital Center, Antananarivo, Madagascar. MethodsWe carried out a cross-sectional, descriptive study of 10 months from January 2019 to October 2019. All patients diagnosed with acute coronary syndrome during this period were included. ResultsSixty-five cases were included. A “typical chest pain” was only encountered in 7.7% of cases. Advanced age (p = 0.04) and sedentary lifestyle (p = 0.03) were associated with the occurrence of silent myocardial ischemia, and. hypertension with a prolonged duration (≥15 minutes) of chest pain (p = 0.03). Dyslipidemia was associated with atypical irradiation of chest pain (p = 0.003). Alcoholism had an impact on pain triggered by effort (p = 0.01) and relieved by rest (p = 0.04). ConclusionThe current symptomatology of acute coronary syndrome is increasingly atypical. Knowledge of the factors that can influence the different characteristics of chest pain could serve as a benchmark in clinical practice in our population.

Wellens syndrome as an independent predictor of in-hospital cardiovascular complications

Introduction Wellens Syndrome was described for the first time in the eighties, as an equivalent pattern of a critical lesion of the anterior descending artery. Different risk factors have been associated with a worse prognosis during hospitalisation in patients with non-ST segment elevation acute coronary syndrome. However, it is unknown whether the presence of Wellens Syndrome alone contributes to an increase in in-hospital cardiovascular complications. Material and method Analytical prospective cohort study in 141 patients with the diagnosis of acute coronary syndrome without ST segment elevation who underwent coronary angiography between 2016 and 2020. Results Wellens syndrome was diagnosed in 64 patients with a mean age of 66.31 ± 12.54, of which 21 patients had a cardiac event during hospitalisation: hemodynamic complication 14 (21.9%), refractory or recurrent angina 4 (6.3%) and Acute myocardial infarction 3 (4.7%) confirming a relative risk (RR): 4.88 (95% confidence interval (CI) 1.92–12.45) p = 0.001. Conclusions The presence of Wellens Syndrome is independently associated with the appearance of cardiac complications during hospitalisation. Key points SW is now known to be a relatively frequent presentation of ACS, not addressed in depth in clinical practice guidelines for NSTEACS. This syndrome is generally caused by a severe ADA occlusion that, if not adequately treated, could evolve into a large infarction. According to the results of the different series published, the incidence of cardiovascular risk factors in SW is similar to other forms of presentation of ischaemic heart disease. At present, the exact relationship between the main cardiovascular risk factors and SW is unknown; in addition to the possible associations of this syndrome with in-hospital cardiovascular complications and its value as a predictor of the occurrence of cardiac complications, elements that are included in the results of the present study.

Chest pain in the emergency department: From score to core-A prospective clinical study.

High-sensitivity troponin assay brought new challenges as we detect elevated concentration in many other diseases, and it became difficult to distinguish the real cause of this elevation. In this notion, diagnosis of acute coronary syndrome (ACS) remains a challenge in emergency department (ED).We aim to examine different approaches for rule-in and rule-out of ACS using risk scores, copeptin, and coronary computed tomography angiography (CCTA).A prospective observational study was designed to evaluate chest pain patients. Consecutive adult patients admitted to the ED with a chief complaint of chest pain due to any cause were included.All patients were followed-up for 6 months after discharge for major adverse cardiovascular events and readmissions. Admission data, ED processes, and diagnoses were analyzed.One hundred forty-six patients were included, average age was 63 ± 13.4 years, and 95 (65.1%) were male. Global Registry of Acute Coronary Events (GRACE) and History, ECG, Age, Risk factors, Troponin (HEART) scores showed good prognostic abilities, but HEART combination with copeptin improves diagnoses of myocardial infarction (area under the curve [AUC] 0.764 vs AUC 0.864 P = .0008). Patients with elevated copeptin were older, had higher risk scores, and were more likely to be admitted to hospital and diagnosed with ACS in ED. For copeptin, AUC was 0.715 (95% confidence interval 0.629–0.803), and for combination with troponin, AUC of 0.770 (0.703–0.855) did not improve rule-in of myocardial infarction. High-sensitivity troponin I assay alongside prior stroke, history of carotid stenosis, dyslipidemia, use of diuretics, and electrocardiogram changes (left bundle branch block or ST depression) are good predictors of myocardial infarction (χ² = 52.29, AUC = 0.875 [0.813–0.937], P < .001). The regression analysis showed that combination of copeptin and CCTA without significant stenosis can be used for ACS rule-out (χ² = 26.36, P < .001, AUC = 0.772 [0.681–0.863], negative predictive value of 96.25%).For rule-in of ACS, practitioner should consider not only scores for risk stratification but carefully analyze medical history and nonspecific electrocardiogram changes and even with normal troponin results, we strongly suggest thorough evaluation in chest pain unit. For rule-out of ACS combination of copeptin and CCTA holds great potential.

Soluble low density lipoprotein receptor-related protein-1 levels in the differential diagnosis of myopericarditis versus acute coronary syndrome

IntroductionDifferential diagnosis of myopericarditis (MPC) versus acute coronary syndromes (ACS) can be difficult in the emergency room (ER). Low density lipoprotein receptor-related protein-1 (LRP-1) is a transmembrane receptor with diverse biological functions. LRP-1 is increased after viral infections as a defense mechanism. sLRP-1 (soluble form) can be measured in the serum. We study the diagnostic sLRP-1 levels in patients with MPC, ACS and healthy controls. MethodsThe study included consecutive patients who were admitted between the dates of 1.1.2018 and 1.1.2019 with the diagnosis of MPC or ACS. All patients reported to the ER with chest pain (CP) and elevated cardiac troponin levels. Control group (n = 61) was selected from healthy subjects. In addition to routine laboratory work up, serum sLRP-1 concentrations were measured on admission. ResultssLRP-1 levels were significantly higher in MPC, compared to controls (p = 0.005) and ACS (p = 0.001). Median (IQR) sLRP-1 levels in MPC, controls and ACS were 7.39 (22.42), 2.27 (1.74), 2.41 (0.98) μg/ml, respectively (p = 0.004). Among the covariates: sLRP-1, age, gender, HDL-C and LDL-C; only sLRP-1 differentiated a diagnosis of MPC versus ACS (OR = 1684, p = 0,046, CI for OR (1008-2812). The area under the curve (AUC) was measured as 0.79 [CI 0.62–0.95] in ROC analysis, p = 0.001; sLRP-1 had 69% sensitivity and 85% specificity for diagnosis of MPC with a cut-off value of 4.3 μg/ml. ConclusionsLRP-1 is a potential biomarker in the differential diagnosis of MPC versus ACS in ER. Future studies are needed to evaluate and develop the utility of sLRP-1 as a diagnostic and prognostic biomarker in MPC.

The importance of clinical risk assessment in reducing the pathway of acute coronary syndrome

Introduction: Early diagnosis of acute coronary syndrome is emergency providers' task. In the last decade, vast amounts of clinical risk stratification scores were developed to decrease the hospital load of patients by selecting them properly. Objective: Together with the diagnostic and therapeutic challenges, decreasing treatment duration is essential for the improvement of acute coronary syndrome prognosis. Our aim was to assess the HEART score's time-and therapy -related effects on acute coronary syndrome detection as a decision support system. Method: We conducted a retrospective, quantitative study at a county state emergency department amongst patients with the myocardial infarction ICD codes. We assessed their admission time, the way they were delivered to the hos-pital, their presenting symptoms, vital parameters, chronic medical conditions, laboratory and imaging results and the time of their admission to the percutan intervention center. We calculated the HEART score retrospectively from the collected data. Results: Our sample size consisted of 360 people. Coronary artery disease (80%) and hypertension (73.3%) were the most common risk factors, while chest pain (80%) and shortness of breath (48.6%) were the most common com-plaints. Coronary artery disease, hypertension and diabetes are not related to percutan coronary intervention admis-sion times (p = 0.110; p = 0.173; p = 0.507). We found a correlation between the presence of chest pain and mortal-ity (p = 0.009). The calculated HEART score had a correlation with the fact of coronary intervention admission (p = 0.005). Conclusion: We conclude that the retrospectively calculated HEART score correlates with percutan coronary inter-vention admission. Choosing the proper risk stratification can increase the lifespan of the patients and hospital cost-efficiency.

Changes in the activity of metalloprotease ADAMTS13 antigen von Willebrand factor in patients with acute coronary syndrome

Introduction. Currently, considerable attention is being given to the study of the interaction of the von Willebrand factor (vWF) and its specific regulator of metalloprotease ADAMTS13 in various clinical conditions accompanied by the development of thrombosis.Aim — to assess the change in the activity of ADAMTS13 metalloprotease and vWF factor antigen in patients with acute coronary syndrome during the first five days after the onset of an anginal attack.Patients and methods: The study included 90 patients aged 42 to 86 years (Me — 61.5 y.o.) hospitalized with a diagnosis of acute coronary syndrome. Of these, 69 were men (Me — 59 y.o.) and 21 women (Me — 63 y.o.). All patients were tested for ADAMTS13 activity, ADAMTS13 antigen, and vWF antigen. Blood samples for the study were obtained upon admission to the hospital (arterial and venous blood), as well as 24, 72 and 120 hours after hospitalization (venous blood).Results. It was found that at all points of the study, in patients without coronary artery thrombosis, the average value of the ADAMTS13 activity indicator was significantly higher compared to the group of patients with coronary artery thrombosis. At the same time, there were no statistically significant differences in the average values of the ADAMTS13 antigen between the compared groups of patients. The mean value of vWF antigen in patients with coronary artery thrombosis was significantly higher compared to that of patients without coronary artery thrombosis.Conclusion. An increase in ADAMTS13 activity was noted more often in patients with acute coronary syndrome without coronary artery thrombosis than in patients with coronary artery thrombosis, which may indicate the antithrombotic effect of ADAMTS13 metalloprotease. No differences were found in ADAMTS13 antigen levels when comparing the study groups of patients, which indicates a greater significance for the anticoagulant activity of the functional characteristics of ADAMTS13. Significantly higher levels of the vWF antigen in patients with coronary artery thrombosis were due to the response to ischemic myocardial injury and stress but were not the primary cause of the thrombotic event.

Comparison of serum troponin level and echocardiographic parameters between male and femal patients with ACS

Background: Acute Coronary Syndrome is one of the commonly diagnosed life threatening condition as of now. Hence it is necessary to diagnose early and assess the severity of disease as soon as possible. Troponin is considered a specific marker for the diagnosis of acute coronary syndrome (ACS). Aim: To estimate the high-sensitivity cardiac troponin (hs-cTn) in Acute coronary syndrome patients. Also to compare serum troponin levels and echocardiographic parameter in patient's gender. Materials and Methods: 70 patients of both sexes who got admitted within 24 hours after onset of symptoms and diagnosed as Acute Coronary Syndrome in Hospital of Baghdad /medical city during the period of December 2020 to December 2021. The (hs-cTn) was measure in the blood with Elisa Assay kit. Results: This study included 70 patients, they divided into two groups: Male group and female group. The control group included 20 healthy persons. There was a significant increase in the frequency of ACS among males in comparison to females (P-value =0.0027). The mean (± SEM) value of serum hs-troponin I concentrations did not differ significantly (p=0.372) as compared with mean (± SEM) value of serum control group.

Migraine and its relation to other risk factors in patients with acute ischemic stroke and acute coronary syndrome

BackgroundMigraine has been recently studied as a risk factor for ischemic stroke (IS) and a possible link to a broader range of ischemic vascular disorders including angina and myocardial infarction is suggested.Objectivesto study migraine and its relation to other risk factors in patients with acute IS and acute coronary syndrome (ACS).Patients and methodsWe studied 200 patients, 114 patients had acute IS and 86 patients with ACS, in addition to 850 control participants. All patients were subjected to detailed clinical and laboratory evaluation; including evaluation of traditional risk factors. All stroke patients were subjected to CT scan. Diagnosis of acute coronary syndrome was established clinically by ECG and cardiac specific enzymes. Migraine was diagnosed according to the international headache society and assessment of migraine severity was measured by the Migraine Disability Assessment (MIDAS) questionnaire.ResultsIn patients with ischemic stroke, Risk Ratios (RR) of migraine was 3.3 for all migrainous patients, higher for migraine with aura (MA). In the cardiovascular group, it was 2.75 and again higher in MA. A positive correlation between migraine severity and both stroke severity and cardiac affection severity was found though non-significant in the cardiovascular group. There was no significant difference in hospital outcome in migrainous patients in both groups.ConclusionsPatients with migraine have higher risk than non-migrainous patients for both cerebrovascular and coronary vascular diseases. Risk is stronger in MA in both conditions. Considering migraine in risk stratification of cerebrovascular and cardiovascular diseases is recommended.

Myocardial Involvement in Systemic Lupus Erythematosus: Not only A Problem of Epicardial Coronary Artery

42-year-old woman, active smoker, with an history of arterial hypertension and SLE, treated with Prednisone and Hydroxychloroquine, was admitted to the Emergency Department (ED) complaining of severe chest pain. Electrocardiogram revealed normofrequent sinus rhythm with negative/diphasic T waves in Infero-lateral leads. Bedside Transthoracic Echocardiogram (TTE) showed mild impairment of ventricular systolic function (EF 50%) in presence of hypokinesia of the anterior wall in mid- basal segment. Cardiac biomarkers were elevated and a diagnosis of acute coronary syndrome without persistent ST Elevation Myocardial Infarction (ASC N-STEMI) was performed. The patient underwent for coronary angiography that revealed coronary arteries free from significant atherosclerotic lesions. Moreover, Cardiac Magnetic Resonance (CMR) showed signs of hypertrophic cardiomyopathy along with T2 hyperintensity and mesocardial Late Gadolinium Enhancement (LGE) in the basal segment of postero- lateral wall consistent with acute myocarditis.

Changes of creatine phosphokinase MB levels in the context of myocardial reperfusion injury

In patients with initially elevated levels of creatine phosphokinase MB (CPK-MB), its increase after percutaneous coronary intervention (PCI) may be due not only to additional injury, but also to natural release during myocardial infarction. Therefore, CPK-MB should be evaluated relative to the initial values.Aim. To compare the CPK-MB dynamics after myocardial reperfusion relative to baseline values and the upper limit of normal (ULN) for the optimal approach to determining myocardial reperfusion injury in patients with acute coronary syndrome.Material and methods. A single center observational study was conducted with the participation of 90 patients hospitalized with a diagnosis of acute coronary syndrome. Patients underwent a biochemical blood test for CPK-MB twice and its dynamics was determined relative to the initial value and ULN.Results. Between the ischemia time and CPK-MB dynamics relative to the initial values, there is a moderate negative correlation. At the same time, the ratio of CPKMB after surgery to ULN is not associated with ischemia time. Analysis of covariance showed that the CPK-MB dynamics, determined relative to the initial values, is 20% dependent on the ischemia time. Individual features of coronary system anatomy, localization of the infarct-associated artery and the subsequent reperfusion procedure together explain the CPK-MB dynamics after surgery by 27%. When the ratio of CPK-MB to ULN is included in the analysis of covariance, all the above factors lose statistical significance.Conclusion. Thus, for a more accurate assessment of myocardial reperfusion injury after PCI, not the upper limit of normal should be analyzed, but the initial values of CPK-MB. In patients with the left heart dominant, as well as in the infarction localization in the system of right or left anterior descending artery, there is a slight change in the marker. On the contrary, more pronounced dynamics is observed in patients with tortuous coronary arteries and with implantation of 2 or more stents. At the same time, the assessment of CPK-MB in relation to ULN is not associated with the ischemia time and does not depend on the clinical and angiographic characteristics and tactics of the operation.

Clinical Significance of Elevated Levels of Cardiac Troponin T in Patients with Chronic Kidney Disease at Lagos University Teaching Hospital, Lagos

Background: This is an observational study of pre-dialysis patients with Chronic Kidney Disease (CKD) attending nephrology clinic at Lagos University Teaching Hospital to determine the clinical significance of elevated levels of Cardiac Troponin T (CTT) and possible associated factors.&#x0D; Methods: One hundred and forty-three (143) patients with CKD and no prior history of myocardial infarction were recruited and their serum levels of CTT were determined within 3 months of sample collection and storage at -80° C. ECG findings and clinical variables were compared. The 99 percentile cut-off value was derived using healthy individuals that met the inclusion criteria.&#x0D; Results: Mean blood CTT level was significantly higher in CKD patients compared to the general population. The 99th percentile value derived in the reference sample population was 48.02pg/ml. Statistical analysis showed significant association of CTT elevation with left ventricular hypertrophy, decreased renal function and age.&#x0D; Conclusion: CTT is generally elevated in pre-dialysis patients with CKD and a single elevated blood level of CTT above the 99th percentile may suggest asymptomatic Acute Coronary Syndrome. Serial rising levels of CTT and other clinical features will be of diagnostic significance in the diagnosis and management of asymptomatic acute coronary syndrome in patients with CKD.&#x0D; &#x0D; Authors&#x0D; O I Ajie , E C Azinge, B T Bello , T A Oshodi , O O Soriyan, I C Udenze &#x0D;

Room for improvement: diagnosing and managing acute coronary syndromes in persons with reduced eGFR

Cardiovascular events are the leading cause of death in chronic kidney disease. A recent analysis from the High-Sensitivity Troponin in the Evaluation of Patients With Suspected Acute Coronary Syndrome trial focused on results in those with reduced estimated glomerular filtration rate. This commentary discusses aspects of acute coronary syndrome diagnosis in this group and the differential approach to acute coronary syndrome management that was observed between those with normal and reduced kidney function.

Barriers and enablers in the implementation of a quality improvement program for acute coronary syndromes in hospitals: a qualitative analysis using the consolidated framework for implementation research

BackgroundIschemic heart disease causes a high disease burden globally and numerous challenges in treatment, particularly in developing countries such as China. The National Chest Pain Centers Program (NCPCP) was launched in China as the first nationwide, hospital-based, comprehensive, continuous quality improvement (QI) program to improve early diagnosis and standardized treatment of acute coronary syndromes (ACS) and improve patients’ clinical outcomes. With implementation and scaling up of the NCPCP, we investigated barriers and enablers in the NCPCP implementation process and provided examples and ideas for overcoming such barriers.MethodsWe conducted a nationally representative survey in six cities in China. A total of 165 key informant interviewees, including directors and coordinators of chest pain centers (CPCs) in 90 hospitals, participated in semi-structured interviews. The interviews were transcribed verbatim, translated into English, and analyzed in NVivo 12.0. We used the Consolidated Framework for Implementation Research (CFIR) to guide the codes and themes.ResultsBarriers to NCPCP implementation mainly arose from nine CFIR constructs. Barriers included the complexity of the intervention (complexity), low flexibility of requirements (adaptability), a lack of recognition of chest pain in patients with ACS (patient needs and resources), relatively low government support (external policies and incentives), staff mobility in the emergency department and other related departments (structural characteristics), resistance from related departments (networks and communications), overwhelming tasks for CPC coordinators (compatibility), lack of available resources for regular CPC operations (available resources), and fidelity to and sustainability of intervention implementation (executing). Enablers of intervention implementation were inner motivation for change (intervention sources), evidence strength and quality of intervention, relatively low cost (cost), individual knowledge and beliefs regarding the intervention, pressure from other hospitals (peer pressure), incentives and rewards of the intervention, and involvement of hospital leaders (leadership engagement, engaging).ConclusionSimplifying the intervention to adapt routine tasks for medical staff and optimizing operational mechanisms between the prehospital emergency system and in-hospital treatment system with government support, as well as enhancing emergency awareness among patients with chest pain are critically important to NCPCP implementation. Clarifying and addressing these barriers is key to designing a sustainable QI program for acute cardiovascular diseases in China and similar contexts across developing countries worldwide.Trial registrationThis study was registered in the Chinese Clinical Trial Registry (ChiCTR 2100043319), registered 10 February 2021.

Clinical value of combined detection of thrombus precursor protein and P-selectin in the diagnosis of acute coronary syndrome

Clinical value of combined detection of thrombus precursor protein and P-selectin in the diagnosis of acute coronary syndrome

A Malaysian Expert Consensus on the Use of High-sensitivity Cardiac Troponin in the Emergency Department

Recent guidelines have recommended using high sensitivity cardiac troponin (hs-cTn) assays to triage patients with suspected acute coronary syndrome. Despite this, less sensitive point-of-care testing is often the preferred choice in majority of hospitals. The aim of this evidence-based, expert consensus is to provide guidance for healthcare professionals in understanding the role of hs-cTn, specifically its level of sensitivity and specificity as well as its practical application in the emergency department setting, particularly in resource-limited centres in Malaysia. An expert panel with clinical and research expertise in the diagnosis and treatment of acute coronary syndrome was convened. Recommendations were based on a comprehensive review of the existing literature using MEDLINE and Embase databases, alongside individual clinical experience within the regional and international context. This expert consensus provides a structured approach to using hs-cTn in the emergency department and remains the only one to date produced by a group of Malaysian experts to help guide Malaysian clinicians dealing with acute chest pain on a daily basis.

Temporal Changes of Stable High-Sensitivity Cardiac Troponin T Levels and Prognosis.

BackgroundThe prognostic implications of temporal change of previously stable high‐sensitivity cardiac troponin concentrations are unknown. We investigated the prognosis associated with temporal changes of stable high‐sensitivity cardiac troponin T (hs‐cTnT) concentrations.Methods and ResultsAll patients presenting with cardiac symptoms and ≥2 hs‐cTnT measurements at the time of their first visit to 7 different emergency departments in Sweden between December 9, 2009, and December 31, 2016, were identified (n=66 159). We included all patients with stable hs‐cTnT but no acute coronary syndrome diagnosis who had ≥1 hs‐cTnT measured also at a second visit >30 days from the first visit. Hazard ratios (HRs) with 95% CIs were calculated for all‐cause mortality and cardiovascular events according to temporal change of hs‐cTnT between the visits, using patients without myocardial injury (<15 ng/L) at the first visit and persistently stable hs‐cTnT at the second visit as the reference. Altogether, 12 869 patients were included, of whom 5191 (40%) had myocardial injury (hs‐cTnT ≥15 ng/L). During a median follow‐up of 2.3 (interquartile range, 1.4–3.7) years, 3271 (25%) patients died. In patients with myocardial injury and a temporal increase in hs‐cTnT, the adjusted all‐cause and cardiovascular mortality was 4‐ and 5‐fold elevated (HR, 4.21; 95% CI, 3.55–5.00; and HR, 5.08; 95% CI, 3.73–6.92), and the adjusted risk of heart failure hospitalization almost 3‐fold (HR, 2.77; 95% CI, 2.26–3.39).ConclusionsTemporal change of previously stable hs‐cTnT is associated with the risk of death and cardiovascular outcomes, with highest risks observed in patients with myocardial injury and increasing hs‐cTnT.

C70 HIGH–SENSITIVE CARDIAC TROPONINS ELEVATION: NOT ONLY A CARDIAC DISEASE. ROLE OF HETEROPHILE ANTIBODIES

Abstract Introduction High–sensitive troponins I and T (hs–TnI and hs–TnT) represents the main biomarkers of Acute Coronary Syndrome diagnosis when combined with ST–T segment changes at ECG and typical clinical presentation. Elevated serum values of cardiac troponins can also be found in several cardiac diseases such as myopericarditis, pulmonary embolism and heart failure, conversely also in non–cardiac diseases. Among them, the analytical interference due to heterophile antibodies (HA) represent a rare non–cardiac cause of troponins elevation. Case Presentation We report a case of a 20–year–old man admitted to our Cardiology department for palpitations and dyspnea, associated with persistently high levels of TnI–HS. He presented no cardiovascular risk factors. During hospitalization the patient was asymptomatic with persistent TnI–HS elevation (1051.4 pg/mL; r.n. 0–34 pg/mL) associated with no CK–MB values changes or typical rise and fall of myocardial damage biomarkers at lab test. Cardiac magnetic resonance excluded myopericarditis or cardiomyopathies in this patient, therefore HA capture test was performed using HA blocking tube reagents. The analytical interference due to HA has been identified with a post–test hs–TnI value of 16.9 pg/mL. Conclusions The analytical interference due to HA is a rare and underestimated cause of false–positive results in cardiac troponin essay, however it should be excluded mostly in young patients without cardiovascular risk factors. Persistent hs–TnI and hs–TnT elevation combined with the absence of typical rise and fall of cardiac troponins and with no CK–MB alterations should help the clinician to recognize this analytical phenomenon at the emergency department.