Early Diagnosis Of Acute Coronary Syndrome Research Articles

Value of cardiodynamicsgram in early diagnosis of patients with acute coronary syndrome

To explore the value of cardiodynamicsgram (CDG) obtained from electrocardiogram (ECG) data by radial basis functionradial basis function (RBF) neural network in early diagnosis of patients with acute coronary syndrome (ACS). Retrospective analysis method was used. Patients with chest pain as the main initial symptom in the emergency department of Baoan District People's Hospital of Shenzhen from October 2021 to September 2022 were enrolled. Baseline data were collected, including gender, age, smoking history, family history of coronary heart disease and history of hypertension, diabetes, hyperlipidemia, and atherosclerosis. The first 12-lead ECG was recorded after admission to the emergency department, and electrocardiodynamics analysis was performed to generate CDG. Receiver operator characteristic curve (ROC curve) was plotted to analyze the value of CDG and ECG in the early diagnosis of ACS and non-ST segment elevation ACS (NSTE-ACS). Sensitivity, specificity, area under the ROC curve (AUC), and 95% confidence interval (95%CI) were calculated. CDG and coronary angiography results of 3 patients with ACS with normal ECG were observed and analyzed. Non-ACS patients with normal ECG but positive CDG were followed for 30 days for adverse cardiovascular events. A total of 384 patients with chest pain were included, including 169 patients with ACS and 215 patients without ACS. The proportion of male (87.0% vs. 53.0%), smoking history (37.9% vs. 12.1%), hypertension (46.2% vs. 22.3%), diabetes (24.3% vs. 7.9%), hyperlipidemia (55.0% vs. 14.0%) and history of atherosclerosis (22.5% vs. 2.3%) in ACS group were significantly higher than those in non-ACS group (all P < 0.05). The ROC curve showed that the AUC of CDG diagnosis of ACS was higher than that of ECG [AUC (95%CI): 0.88 (0.66-0.76) vs. 0.71 (0.84-0.92)], the sensitivity was 92.8%, 78.6%, and the specificity was 83.3%, 64.2%, respectively. The AUC of CDG diagnosis of NSTE-ACS was higher than that of ECG [AUC (95%CI): 0.85 (0.80-0.90) vs. 0.63 (0.56-0.69)], the sensitivity was 87.1%, 61.3%, and the specificity was 83.3%, 64.2%, respectively. CDG of 3 patients with ACS with normal ECG showed disordered state, and coronary angiography showed ≥70% stenosis of major coronary branches. Of 215 non-ACS patients, 20 had a normal ECG but positive CDG, and 3 developed ST segment elevation myocardial infarction (STEMI) within 30 days, and 2 developed unstable angina (UA) within 30 days. CDG has high value in early diagnosis of ACS patients and is expected to become an important means of early diagnosis of ACS in emergency.

Auxiliary roles of nardilysin in the early diagnosis of acute coronary syndrome: a prospective cohort study, the Nardi-ACS study.

Acute coronary syndrome (ACS) includes myocardial infarction (MI) and unstable angina (UA). MI is defined by elevated necrosis markers, preferably high-sensitivity cardiac troponins (hs-cTn). However, it takes hours for cTn to become elevated after coronary occlusion; therefore, difficulties are associated with diagnosing early post-onset MI or UA. The aim of this prospective cohort study was to examine the diagnostic ability of serum nardilysin (NRDC) for the early detection of ACS. This study consisted of two sequential cohorts, the Phase I cohort, 435 patients presenting to the emergency room (ER) with chest pain, and the Phase II cohort, 486 patients with chest pain who underwent coronary angiography. The final diagnosis was ACS in 155 out of 435 patients (35.6%) in the phase I and 418 out of 486 (86.0%) in the phase II cohort. Among 680 patients who presented within 24h of onset, 466 patients (68.5%) were diagnosed with ACS. Serum NRDC levels were significantly higher in patients with ACS than in those without ACS. The sensitivity of NRDC in patients who presented within 6h after the onset was higher than that of hsTnI, and the AUC of NRDC within 1h of the onset was higher than that of hsTnI (0.718 versus 0.633). Among hsTnI-negative patients (300 of 680 patients: 44.1%), 136 of whom (45.3%) were diagnosed with ACS, the sensitivity and the NPV of NRDC were 73.5 and 65.7%, respectively. When measured in combination with hsTnI, NRDC plays auxiliary roles in the early diagnosis of ACS.

Hollow Crystallization COF Capsuled MOF Hybrids Depict Serum Metabolic Profiling for Precise Early Diagnosis and Risk Stratification of Acute Coronary Syndrome.

Acute coronary syndrome (ACS), comprising unstable angina (UA) and acute myocardial infarction (AMI), is the leading cause of death worldwide. Currently, lacking effective strategies for classifying ACS hinders the prognosis improvement of ACS patients. Disclosing the nature of metabolic disorders holds the potential to reflect disease progress and high-throughput mass spectrometry-based metabolic analysis is a promising tool for large-scale screening. Herein, a hollow crystallization COF capsuled MOF hybrids (UiO-66@HCOF) assisted serum metabolic analysis is developed for the early diagnosis and risk stratification of ACS. UiO-66@HCOF exhibits unrivaled chemical and structural stability as well as endowing satisfying desorption/ionization efficiency in the detection of metabolites. Paired with machine learning algorithms, early diagnosis of ACS is achieved with the area under the curve (AUC) value of 0.945 for validation sets. Besides, a comprehensive ACS risk stratification method is established, and the AUC value for the discrimination of ACS from healthy controls, and AMI from UA are 0.890, and 0.928. Moreover, the AUC value of the subtyping of AMI is 0.964. Finally, the potential biomarkers exhibit high sensitivity and specificity. This study makes metabolic molecular diagnosis a reality and provided new insight into the progress of ACS.

PS-BPB02-7: THE ROLE OF NEUTROPHIL TO LYMPHOCYTE RATIO AS PREDICTIVE BIOMARKER IN ACUTE CORONARY SYNDROME: A SYSTEMATIC REVIEW AND META-ANALYSIS

Introduction: Current evidence suggests that the the neutrophil/lymphocyte ratio (NLR) is growing as a prognostic marker in patient with cardiovascular disease. It has been reported expanding evidence that involves innate and adaptive immune cell in the pathogenesis of Acute Coronary syndrome (ACS) which indicate the pivotal role of NLR as valuable diagnostic parameter in ACS patient. Purpose: The objective of our meta-analysis is to investigate the association of neutrophil lymphocyte ratio (NLR) for ACS risk and the prognostic utility of NLR in ACS patients. Method: We conducted a systematic literature search on various databases such as PubMed, Cochrane and Scopus to identify the relevant articles published until October 2021. Data extracted were pooled using odds ratios (OR) for incidence of ACS and non- ACS patients between high and low NLR. For studies that did not provide these estimates, data were extracted using weighted mean difference (WMD) of NLR for ACS and non-ACS patients. A random effects model was used to conduct this MA. The receiver operating characteristic (ROC) curve was utilized to analyze the prognostic ability of NLR in the ACS patients. Heterogeneity was evaluate using Cochran's Q- and the I 2 − test. GRADE was used to assess the study's quality. The presence of publication bias was evaluated by Egger's test and by visual inspection of the symmetry in funnel plots. Data analysis was conducted using Stata. Results: Nine studies met the inclusion criteria with more than 5215 participants. The MA that used OR as effect size was 1.44 (95% CI:1.082–1.92) with low heterogeneity (Chi- square = 6.2; P-value = 0,0012 I2 = 12.8%). The analyze that used WMD as effect size was 1.24 (95% CI: 1.04- 1.43) with high heterogeneity (Chi-square = 102.7; P-value &lt; 0.001 I2 = 95.1%). There was no evidence of publication bias from Egger's test for OR effect size MA and for WMD MA (coefficient = 0.58; P-value = 0.558) and (coefficient = 3.06; P-value = 0.361). The ROC curve shows that AUC (ACS) = 88.8% (95% CI:0.73 – 1). The best cut- off point of the N/L was 4, with a sensitivity of 82.8 % and a specificity of 77.7 % Conclusion: The MA that used OR as effect size indicated high NLR was significantly associated with increased risk of ACS. The analyze that used WMD as effect size indicated mean NLR was significantly higher in ACS patients than in non-ACS patients. ROC curve analysis was significant for NLR in diagnosing ACS. Therefore, our results conclude that the NLR effect was strongest on ACS outcome and might also help in early diagnosis of ACS and all this make NLR a predictive biomarker in ACS patient .

Effect of Serum Netrin-1 Levels on Diagnosis and Prognosis in Patients Admitted to the Emergency Service for Acute Coronary Syndrome.

BackgroundNetrin-1 is a recently discovered diagnostic biomarker that indicates atherosclerosis, angiogenesis, and ischemia-reperfusion damage. There are no human studies about Netrin-1 in acute coronary syndrome (ACS). The purpose of the present study was to investigate Netrin-1 levels in the early diagnosis and successful reperfusion of ACS.MethodThe study was conducted with 188 patients diagnosed with ACS and 50 healthy subjects at the emergency unit in a prospective design. Blood samples were collected from the patient group at initial admission and after angiography. The control group consisted of healthy adult subjects without any disease. Netrin-1 levels were studied in both groups.ResultsThe Netrin-1 levels of the patient group at the time of admission were found to be higher than of the control group (p<0.001). In the patient group, netrin-1 levels measured at initial admission (1.53±0.19) and after angiography (1.49±0.19) were determined to be statistically significant (p:0.049). In the patient group, where the Thrombolysis in Myocardial Infarction (TIMI) 3 flow was established after angiography, netrin-1 levels were detected to be low (p:0.039). Netrin-1 levels obtained at the time of admission were determined to be significantly different in the Global Registry of Acute Coronary Events (GRACE) moderate and high-risk groups in comparison to the low-risk group (p:0.017).ConclusionNetrin-1 was shown to increase in the early diagnosis of ACS and to decrease in patients for whom reperfusion was established after angiography. Therefore, Netrin-1 can be an important biomarker as an indicator of diagnosis and successful reperfusion in ACS.

The thromboelastography G parameter as a potential biomarker of acute coronary syndrome

The most prominent event that defines acute coronary syndrome (ACS) is the formation of an intra-arterial thrombus, usually resulting from activation of platelet and fibrinogen at the ruptured plaque. Usually, conventional coagulation tests (CCTs) are used to estimate the hemostatic properties of patients. However, CCTs have significant limitations because they each assess individual aspects of the coagulation cascade, which is a complex multifaceted process. And CCTs are performed with platelet-poor plasma, while the contribution of platelets to clot formation is not measured. In contrast, thromboelastography (TEG) is a test for global hemostasis with whole blood, from the beginning of coagulation through clot formation to the ending with fibrinolysis. The aim of this study was to investigate whether TEG parameters could be surrogate biomarkers of thrombus formation process and diagnosis of ACS. Receiver operating characteristic（ROC）curve was used to evaluate the diagnosis performance of each index. Logistic regression analysis was utilized to define the independent risk factors of ACS. The results showed that the shear elastic modulus parameter (G) was an independent diagnostic indicator for ACS (odds ratio [OR], 2.600; 95% confidence interval [CI], 2.035–3.322). The area under ROC curve of G was 0.866. The optimal cut-off value for the diagnosis of ACS was 10.55 dyne/cm2, while the sensitivity was 66.2% and the specificity was 92.4%. In conclusion, G could be used as an optimal indicator of activation of platelet and fibrinogen, which is eligible to be a useful biomarker for early diagnosis of ACS.

Role of Gal-3 and H-FABP in the early diagnosis of acute coronary syndrome.

We aimed to compare the plasma levels of biomarkers such as: serum Gal-3, H-FABP, cTnI, and CK-MB in patients, who were admitted to the emergency room with chest pain, and to determine whether these biomarkers have early diagnostic value of acute coronary syndrome (ACS). The study was performed in 60 patients aged ≥ 18 years, who were admitted to emergency room. These patients were divided into 3 groups: patients with STEMI (group I, n = 20), patients with NSTEMI (group II, n = 20), and patients with USAP (group III, n = 20). Serum Gal-3, H-FABP, cTnI, and CK-MB levels were measured at admission, and at the 2nd and 4th hours. There were statistically significant differences between the groups in terms of Gal-3 levels at admission, and the 2nd and 4th hours (p = 0.007, p = 0.002, and p = 0.001, respectively). There were statistically significant differences between the groups in terms of H-FABP levels at admission, and the 2nd and 4th hours (p = 0.001, p = 0.003, and p = 0.003, respectively).There were statistically significant differences between the groups in terms of cTnI levels at admission, and the 2nd and 4th hours (p < 0.001, p < 0.001, and p < 0.001, respectively). According to the results of the study, cTnI, H-FABP, and Gal-3 are useful parameters that can be used in the early diagnosis of ACS (Tab. 4, Ref. 36).

Diagnostic Accuracy of Prehospital Tele-Electrocardiography in Acute Coronary Syndrome.

Tele-electrocardiography (tele-ECG) is a powerful ally in the screening of acute ischemic lesions. Evidence that confirms the correlation between the diagnosis of acute coronary syndrome (ACS) determined in the prehospital setting and the confirmation of the diagnosis in the hospital setting is scarce. This study compares the presumed diagnosis of ACS in the prehospital setting based on electrocardiographic changes, such as ST-segment deviation, with the diagnosis confirmed in a hospital setting. Retrospective, cross-sectional analysis of medical records of patients who sought emergency ambulance services of a distinguished public healthcare service in the city of Porto Alegre from September 2013 to August 2014. Data were collected from tele-ECG recordings and medical records available at the database of the Secretary of Health. The study was based on the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Among the 1,338 prehospital examinations performed, a total of 250 admissions in tertiary hospitals were registered. There was a significant agreement (p < 0.01) of 71% of the electrocardiographic changes identified in the prehospital setting with the diagnosis of ACS confirmed in the hospital setting. These changes were more prevalent in men (p = 0.048) and in patients aged 60 years or older (p = 0.006). The tele-ECG allows the early diagnosis of ACS, reducing the delay to definitive treatment, be it reperfusion, chemical, or mechanical therapy. Seventy-two percent of the prehospital diagnosis of ACS based on electrocardiographic changes was later confirmed in the hospital setting.

The year in cardiology 2016: acute coronary syndromes.

The year 2016 brought us several studies on the pathophysiology of acute coronary syndrome (ACS), in particular, on the role of basophils and eosinophils in the mechanism of disease. New puzzling data have also emerged on the pathomechanisms of very late stent thrombosis and the role of neutrophils in ventricular remodelling. New information has also been published on the early diagnosis of ACS by high sensitivity troponin (hsTn) and the role of new exciting biomarkers and clinical scores on risk stratification. With regards to antithrombotic treatment, the year 2016 has brought important new data on the duration of dual antiplatelet therapy (DAPT) and on the management of the growing population of very elderly. Finally, new interesting information has been published on the outcome of specific patient subsets. The studies reported in this review are summarized in Table 1 . View this table: Table 1 Summary of the main studies ### Pathogenesis of ACS Spontaneous ACS can be caused by plaque fissure, plaque erosion, or functional alterations of epicardial coronary arteries or by vasoconstriction of the microcirculation. Activation of inflammatory cells plays a key role in both plaque fissure and erosion although the mechanisms leading to plaque instability are substantially different in these two conditions. Indeed, while monocyte and lymphocyte activation is the key alteration in plaque fissure, neutrophil activation is a crucial player in plaque erosion. The role of eosinophil and basophil activation is still largely unknown. Niccoli et al. 1 found a higher degree of both eosinophil and basophil activation, as assessed by flow cytometry, in patients with ACS than in those with stable angina. Furthermore, in a prospective cohort study they found that higher levels of eosinophil cationic protein (ECP) were associated with a worse outcome during follow-up. This suggests that novel therapies targeting eosinophils should be tested in ACS patients exhibiting raised ECP levels. ### Stent thrombosis It is …

The year in cardiology 2015: acute coronary syndromes

The year 2015 has been productive in studies on pathophysiology of ACS. In particular on the different mechanisms of disease and related outcomes. New information has been published on the early diagnosis of ACS and on prevention and treatment of microvascular obstruction. With regard to antithrombotic treatment, the year 2015 has brought important new data that will change practice. Both the European Society of Cardiology (ESC)1 and the American College of Cardiology/American College of Cardiology (ACC/AHA)2 have published new guidelines on the management of acute coronary syndromes (ACS) in patients without persistent ST-segment elevation. In this review, we briefly highlight new recommendations only. With regard to early diagnosis of myocardial infarction (MI) ESC guidelines, for the first time, give a 1B recommendation for a rapid rule-out and rule-in protocol at 0 and 1 h if a high-sensitivity cardiac troponin test with a validated 0/1 h algorithm is available, with additional testing after 3–6 h if the first two troponin measurements are not conclusive and the clinical condition is still suggestive of ACS, while ACC/AHA recommend to measure troponin at presentation and 3–6 h after symptom onset. Both guidelines recommend an immediate invasive strategy within 2 hours of presentation in very high-risk patients, an early invasive strategy within 24 h in high-risk patients and an invasive strategy within 72 h in intermediate risk patients. Finally, ESC guidelines give 1A recommendation for the radial approach in experienced centres and provide a new flow chart for the management of antithrombotic drugs in patients with concomitant non-valvular atrial fibrillation ( Figure 1 ). They also give for the first time 3B recommendation for not to preloading patients in whom …

Assessing sensitivity and specificity of the Manchester Triage System in the evaluation of acute coronary syndrome in adult patients in emergency care: a systematic review protocol.

REVIEW QUESTION / OBJECTIVE The objective of this review is to assess the sensitivity and specificity of the Manchester Triage System in the evaluation of adult patients with acute coronary syndrome in emergency departments. INCLUSION CRITERIA Types of participants This review will consider studies that include adult patients (over 18 years) who have sought emergency care with any complaint, have been classified by the Manchester Triage System, and have received a medical diagnosis of Acute coronary syndrome. Studies involving children (18 years or under) will be excluded, as although the instrument can be used for evaluating children, this is a population with very specific characteristics, and the inclusion of studies conducted on children could bias the results. Furthermore, Acute coronary syndrome generally affects the adult population and incidences are highly related to risk factors such as age, sex, smoking, hypertension and diabetes. Types of intervention(s)/phenomena of interest This review will consider studies that evaluate the use of the Manchester Triage System without modifications in risk classification of patients. No comparator will be used. Types of outcomes This review will consider studies that include the following outcome measures: Priority level established by the Manchester Triage System in the evaluation of patients with medical diagnosis of Acute coronary syndrome. Analysis of the sensitivity or specificity of Manchester Triage System in the evaluation of patients with Acute coronary syndrome. The Manchester Triage System can be seen as a test; in the case of evaluation of patients with Acute coronary TRUNCATED AT 250 WORDS

A Synergistic Role of Myeloperoxidase and High Sensitivity Troponin T in the Early Diagnosis of Acute Coronary Syndrome

Aim of this study was to evaluate the role of Myeloperoxidase (MPO) and high sensitive Troponin T in the early diagnosis of acute coronary syndrome (ACS). This was a cross sectional study that comprised of 120 individuals of which 75 were cases and 45 healthy controls. On the basis of clinical history and 12 lead electrocardiogram initial diagnosis of ACS was made in the cases. MPO and high sensitive Troponin T (hs-cTnT) was measured in all the individuals. Levels of MPO were significantly higher in patients of ACS as compared to those in control group [medians: 15.40 (95% CI 11.06-20.84) vs 5.84 (95% CI 5.50-6.44)]. By taking the cut off as >11.87U/mL for MPO, its sensitivity was 87% (95% CI 73.7-95.1), specificity was 97.3% (95% CI 90.6-99.7), positive predictive value was 94.6% and negative predictive value was 92.6%. Positive likelihood ratio was 33.0 while negative likelihood ratio was 0.13, whereas the corresponding values in case of hs-cTnT were 95.6% (95% CI 85.2-99.5), 61.3% (95% CI 49.5-72.6), 59.7%, 95.8%, 2.47 and 0.07 by taking cut off as >14pg/ml. The area under the ROC curves (AUC) of MPO and hscTnT at 0-6h were 0.971 (95% CI 0.92-0.99, P<0.001) and 0.797 (95% CI 0.71-0.86, P<0.001) respectively. The logistic model combining the two markers yielded sensitivity, specificity, positive predictive value and negative predictive value of 95.7, 97.3, 98.2 and 93.7% respectively. It was concluded that MPO and hs-cTnT may be useful tools for risk stratification of ACS and can be used together with better accuracy in the early diagnosis of ACS.

A synergistic role of ischemia modified albumin and high-sensitivity troponin T in the early diagnosis of acute coronary syndrome.

Aim:The aim was to evaluate the role of high sensitivity troponin T and ischemia modified albumin (IMA) and in the early diagnosis of acute coronary syndrome (ACS).Materials and Methods:This was a cross-sectional study that comprised of 120 individuals of which 75 were cases and 45 healthy controls. On the basis of clinical history and 12-lead electrocardiogram, initial diagnosis of ACS was made in the cases. High sensitive cardiac troponin T (hs-cTnT) and IMA were measured in all the individuals.Results:Levels of IMA were significantly higher in patients of ACS as compared to those in control group (means: 101.83 [95% confidence interval (CI): 91.96–111.70] vs. 41.11 [95% CI: 38.55–43.67]). By taking the cut-off as >65.23 U/mL for IMA, which was obtained from receiver operating characteristic (ROC) curve, the sensitivity was 91.3%, specificity was 81.1%, positive predictive value (PPV) was 74.4%, and negative predictive value (NPV) was 93.9%. Positive likelihood ratio was 4.83 while negative likelihood ratio was 0.11, whereas the corresponding values in case of hs-cTnT were 95.6% (95% CI: 85.2–99.5), 61.3% (95% CI: 49.5–72.6), 59.7%, 95.8%, 2.47 and 0.07 by taking cut-off as >14 pg/mL. The area under the ROC curves (AUC) of IMA and hs-cTnT at 0–6 h were 0.932 (95% CI: 0.87–0.97, P < 0.001) and 0.797 (95% CI: 0.71–0.86, P < 0.001), respectively. The logistic model combining the two markers yielded sensitivity, specificity, PPV, and NPV of 95.7%, 81.1%, 88.6%, and 92.5% respectively.Conclusion:hs-cTnT and IMA may be useful tools for risk stratification of ACS and can be used together with better accuracy in the early diagnosis of ACS.

Ischaemia Modified Albumin as a New Biomarker in the Early Diagnosis of Acute Coronary Syndrome

Ischaemia Modified Albumin as a New Biomarker in the Early Diagnosis of Acute Coronary Syndrome Background: Early identification of acute coronary syndrome (ACS) is important. CK-MB and cardiac troponins show a delayed rise approximately 3 to 6 hours after the onset of pain. Ischaemia modified albumin (IMA) has been licensed through FDA for the early diagnosis of myocardial ischaemia. This study aimed to assess the role of IMA in the early diagnosis of ACS. Methods: This study was conducted on 60 patients who were admitted in the Cardiac Care Unit (CCU) of Benha University Hospitals with acute chest pain less than 3 hours before admission. All patients underwent serial IMA and cardiac troponin T (cTnT) both at presentation and after 8 hours. Patients were divided into two groups according to the discharge diagnosis: non-ischaemic or ischaemic chest pain group. This classification based on criteria of pain, ECG changes, and wall motion abnormalities by echocardiography plus positive cTnT. Sensitivity, specificity, positive (PPV) and negative predictive values (NPV) for both IMA and cTnT were analyzed. Results: Using 75 ng/dl as a cut off value for IMA and 0.04 ng/ dl for cTnT, the sensitivity and NPV of IMA to rule out ischaemia was greater as compared to that of cTnT (70.6% & 63% vs 44.1% & 42.2%). The combination between the IMA and the cTnT results improved the sensitivity and NPV up to 85.3% at presentation and up to 100% 8 hours after admission. Conclusion: IMA is a useful marker for the early rule out of ACS. Negative IMA (<75 ng/dl) and cTnT (<0.04 ng/dl) values plus normal or non-specific ECG changes could safely rule out the ischaemic etiology of chest pain early after presentation.

Utility of serum ischemia modified albumin in the early diagnosis of acute coronary syndrome

Context: Coronary artery disease (CAD) is the leading cause of death. Early detection of myocardial ischemia can decrease morbidity and mortality due to CAD. Ischemia modified albumin (IMA) is a newer biomarker for early detection of myocardial ischemia in patients of acute coronary syndrome (ACS) as compared to cardiac troponin T (cTnT). Aims: The aim of this study was to test the utility of IMA, a new biomarker of myocardial ischemia, in the early diagnosis of ACS. Settings and Design: The cross-sectional study group consisted of 101 patients between the age group of 27 and 85 years having ACS and 100 control from a healthy population. Materials and Methods: Blood was collected from all the enrolled patients immediately after admission, and samples were analyzed for cTnT on the fully automated analyzer and IMA on a spectrophotometer. Statistical Analysis Used: Statistical analysis was carried out by calculation of the area under a curve using receiver operating characteristics (ROC) curve analysis for the IMA test in the 101 patients included in the study population. Results: ROC curve area for IMA was 0.89 (95% confidence interval 0.81-0.94). At the cut-off 95 U/ml, sensitivity, and specificity were 85% and 82% and positive predictive value and negative predictive value (NPV) were 88% and 78%, respectively. Conclusions: IMA is a useful ischemic marker for diagnosis of myocardial ischemia due to high sensitivity, and it also facilitates to rule out myocardial ischemia due to high NPV.

Association study of plasma NT-proBNP levels and severity of acute coronary syndrome.

The aim of this study was to investigate the N-terminal brain natriuretic peptide precursor (NT-proBNP) levels in the peripheral blood of patients with acute coronary syndrome (ACS) and to provide the basis for its application in the early diagnosis of ACS. A total of 440 patients admitted to the hospital for examination and treatment were enrolled, including 330 patients with ACS and 110 cases in the control group. Routine blood examination and determination of NT-proBNP in all subjects were conducted immediately at the time of admission to analyze the difference in plasma NT-proBNP between the two groups. The plasma NT-proBNP levels in ACS were significantly higher (P < 0.01) and were associated with the severity of coronary lesions. The present study indicated that the plasma NT-proBNP level in ACS patients is significantly increased and has a potential value in the early diagnosis of ACS.

Comparison between quantitative and qualitative biochemical markers in the diagnosis of acute coronary syndrome

Objectives: To compare between the qualitative estimation of biochemical markers Point-of-Care testing) with the quantitative estimation of the same markers in the diagnosis of acute coronary syndrome (ACS). Design: Case-series study. Setting: This study was carried out in coronary care unit in Ibn- Sena Teaching Hospital in Mosul city from January to November, 2008. Participant: Sixty five patients with acute coronary syndrome (ACS) presented with chest pain. Main outcome measures: Three cardiac markers (Creatine kinase (CK-MB) activities (marker of necrosis), myoglobin (marker of muscle injury), and troponin I (marker of necrosis), were estimated qualitatively (near the patient= Point-of-Care testing), and quantitatively, and the results were compared. Kappa test was used for the association between the quantitative and qualitative test results. Results: The case-series study showed correlation of attributes between qualitative estimation results of troponin I, myoglobin and CK-MB and quantitative estimation results of the same parameters in (88.9%) tests. Conclusion: The early diagnosis of ACS might be facilitated by the use of qualitative point-of-care testing based on CK-MB, troponin I and myoglobin tests.

Comparative diagnostic accuracy of serum levels of neutrophil activating peptide-2 and pentraxin-3 versus troponin-I in acute coronary syndrome

We measured the levels of neutrophil activating peptide-2 (NAP-2) and pentraxin-3 (PTX-3) in acute coronary syndromes (ACS) patients and compared their diagnostic accuracy with cardiac troponin I (cTnI). We conducted a prospective cohort study to determine the diagnostic accuracy of PTX-3, NAP-2 and cTnI for the prediction of ACS. Consecutively eighty-three patients with sudden chest pain admitted to Dicle University Emergency Department within the first six hours of symptom onset were included in our study. Mean serum levels of PTX-3, NAP-2 and cTnI were compared between control and patient groups and ACS subgroups. Their sensitivities and specificities in early diagnosis of ACS were identified. Receiver operating characteristic (ROC) analysis was used to assess the diagnostic validity of the markers, and areas under the ROC curve (AUC) were compared. In the patient group, mean serum concentrations of NAP-2 (53.03+22.77 ng/ml) and PTX-3 (1.73+0.82 ng/ml) were considerably higher than those of the control group (24.54+9.50 and 0.50+0.39 ng/ml, respectively) (p<0.01). When compared with the control group, PTX-3 levels of all three ACS subtypes (unstable angina pectoris (USAP) - 1.62+0.41 ng/ml, non-ST elevation myocardial infarction (NSTEMI) -1.63+0.31 ng/ml and ST-elevation myocardial infarction (STEMI) - 1.75+0.89 ng/ml) were higher, whereas NAP-2 levels were higher in USAP (56.29+22.60 ng/ml) and STEMI (52.05+20.99 ng/ml) patients (p<0.01). For diagnosing ACS within the first six hours of presentation, PTX-3 sensitivity was 98.5% and specificity was 92.3%, and NAP-2 sensitivity - 98.1% and specificity - 41.3%. The ROC curve AUC values were: 0.962 for PTX-3 (95% CI 0.802 - 1.073), 0.840 for NAP-2 (95% CI 0.684 - 0.991), and 0.683 for cTnI (95% CI 0.610 - 0.940). Pentraxin-3 is a sensitive and specific marker for ACS diagnosis when compared with cardiac markers in patients admitted to the emergency department (ED) within the first six hours of onset of chest pain.

The role of the heart-type fatty acid binding protein in the early diagnosis of acute coronary syndrome and its comparison with troponin I and creatine kinase-MB isoform

Objectives The aim of this study was to research the effectiveness of the heart-type fatty acid binding protein (H-FABP) in the early diagnosis of acute coronary syndrome (ACS) in patients admitted to emergency service (ES) within 6 hours of onset of chest pain. Equipment and Method A total of 83 patients admitted with chest pain to our ES were included in this study. The patients were divided into 2 groups: those with a diagnosed ACS and those diagnosed with non–cardiac-related chest pain. Patients were also were divided into 2 groups according to the time of admission: those admitted within 0 to 3 hours and 3 to 6 hours of onset of chest pain. Peripheral venous blood samples were obtained from all patients for H-FABP, troponin I, and creatine kinase-MB (CK-MB) serum concentration measurements. Results Of a total of 83 patients, 21.6% (n = 18) were in the control group and 78.3% (n = 65) were in the ACS group. The average H-FABP value for the patients in the control group was 0.86 ± 0.54 ng/mL. When the ACS and control groups were compared in means of cardiac markers for CK-MB ( P = .000) and H-FABP ( P = .000), there was a statistically significant difference, whereas no difference was observed for troponin I ( P = .013). In the ACS group, H-FABP sensitivity for diagnosis was found to be 98% and specificity was 71%; CK-MB sensitivity was 86% and specificity was 52%; and troponin I sensitivity was 77% and specificity was 20%. Conclusions For patients admitted with chest pain to ES, H-FABP was found to be more sensitive and specific than troponin I and CK-MB in the early diagnosis of ACS.

Generation of monoclonal antibodies against a soluble form of lectin-like oxidized low-density lipoprotein receptor-1 and development of a sensitive chemiluminescent enzyme immunoassay

Lectin-like oxidized low-density lipoprotein receptor-1 (LOX-1), expressed prominently in atherosclerotic lesions, is cleaved and released as a soluble LOX-1 (sLOX-1), which is a specific biomarker to diagnose acute coronary syndrome (ACS) at an early stage. Although sLOX-1 levels in patient's blood were successfully measured with our previously established enzyme-linked immunosorbent assay (ELISA), the assay was not sensitive enough to detect normal serum levels of sLOX-1 in healthy human subjects. We therefore developed sensitive and specific monoclonal antibodies (mAbs) against sLOX-1 in order to establish a more sensitive immunoassay. Mice were immunized with recombinant human LOX-1 extracellular domain. mAbs were subsequently generated by standard myeloma cell fusion techniques with a novel screening method using time-resolved fluorescence immunoassay. Using two anti-human sLOX-1 mAbs and alkaline phosphatase as a label, a sandwich chemiluminescent enzyme immunoassay (CLEIA) was developed. In total, nine mAbs were obtained. The dissociation constant ( K d) values of these mAbs for sLOX-1 were 0.12–1.32 nM. Characteristics of these mAbs were estimated and the best combination for CLEIA was selected. The newly established CLEIA could determine sLOX-1 levels as low as 8 pg/mL, and thus, was sensitive enough to measure serum sLOX-1 levels in normal human subjects and to evaluate subtle differences. Values for sLOX-1 measured by monoclonal CLEIA and polyclonal ELISA were highly correlated ( r 2 = 0.7594, p < 0.0001). Area under the curve values of the receiver-operating characteristic curves in detecting ACS were 0.948 and 0.978 for monoclonal CLEIA and polyclonal ELISA, respectively. Thus, a more sensitive sLOX-1 CLEIA was established using newly developed mAbs against sLOX-1. In addition to its advantage in early diagnosis of ACS, this assay may also be useful in predicting cardiovascular disease risk in disease-free subjects.