Infarction In Chest Pain Patients Research Articles

Combination of Platelet expression of PKCepsilon and cardiac troponin-I for early diagnosis of chest pain patients in the emergency department

A rapid differential diagnosis of the clinical conditions underlying chest pain is a relevant clinical issue. Specifically, a fast rule-in or -out of acute myocardial infarction (AMI) is mandatory to improve diagnostic outcome and cost-effectiveness of patient management. We demonstrated that Protein Kinase C (PKC) epsilon is selectively expressed by platelets from AMI patients, accounting for increased platelet activation. Thus, we hypothesized that PKCepsilon-expressing platelets may represent a pathophysiological marker of AMI that could be utilized in combination with troponin-I, the conventional marker of cardiac injury, to add diagnostic information in chest pain workup. In 94 chest pain patients consecutively admitted to Parma University Hospital, we tested the diagnostic performance of flow-cytometric detection of PKCepsilon expressing platelets in discriminating AMI vs. non-AMI conditions. We demonstrated that PKCepsilon-expressing platelets were significantly higher in patients with AMI. Flow cytometry detection of PKCepsilon-expressing platelets showed high sensitivity and specificity (87.5% and 84.4%, respectively) and good diagnostic accuracy (AUC: 0.875). The combination of PKCepsilon expressing platelets and cardiac troponin clearly discriminates patients with 100% and 0% of probability to be affected by AMI. Overall, we highlighted a dual marker strategy potentially useful for a rapid rule-in or -out of myocardial infarction in chest pain patients.

P3666A simplified HEART-score improves discrimination for myocardial infarction in chest pain patients presenting to the emergency department

P3666A simplified HEART-score improves discrimination for myocardial infarction in chest pain patients presenting to the emergency department

Age and Gender Tailored Cutoff Value of hs-cTnT Contributes to Rapidly Diagnose Acute Myocardial Infarction in Chest Pain Patients.

Hs-cTnT concentrations are age and gender related, therefore establishment of age and gender optimized cutoff values for hs-cTnT might be essential. We aimed to define the age and gender specific hs-cTnT 99th percentile in reference population and assess its diagnostic and prognostic performance in patients with suspected AMI. In this prospective study, 1725 healthy individuals (18 - 97 years old) and 812 patients (15 - 98 years old) with chest pain with suspected AMI presenting to the emergency department were enrolled. The measurement of biomarkers was performed at presentation and at 3 - 4 hours according to clinical requirement. We stratified the reference population by age and gender through applying strict exclusion criteria. Clinical follow-up was obtained after 2 years. The 99th percentile of hs-cTnT according to age and gender in adult Han population of Northern China is reported. The cutoff values of hs-cTnT in for subjects < 70 years, 70 - 79 years, and ≥ 80 years was 16 ng/L, 38 ng/L, and 57 ng/L, respectively. Among the 812 patients with chest pain, according to the age and gender tailored cutoff value, the specificity and positive predictive value of AMI diagnosis were increased from 53.9% to 72.2% and 48.6% to 60.8%, compared to 14 ng/L commonly recommended. Cumulative 2-year survival rate for patients with hs-cTnT levels above 14 ng/L was 93.3% compared to 99.5% in patients below that level (p < 0.001). The same was observed for the age and gender tailored cutoff value which was 92.5% compared to 98.5%, respectively (p < 0.001). Age and gender tailored cutoff value for hs-cTnT provides better diagnostic information, but yields no additional prognostic performance for risk prediction of death or major adverse cardiovascular events.

Copeptin Improves Early Diagnosis of Acute Myocardial Infarction

Early identification of myocardial infarction in chest pain patients is crucial to identify patients at risk and to maintain a fast treatment initiation. The aim of the current investigation is to test whether determination of copeptin, an indirect marker for arginin-vasopressin, adds diagnostic information to cardiac troponin in early evaluation of patients with suspected myocardial infarction. Between January 2007 and July 2008, patients with suspected acute coronary syndrome were consecutively enrolled in this multicenter study. Copeptin, troponin T (TnT), myoglobin, and creatine kinase-myocardial band were determined at admission and after 3 and 6 h. Of 1,386 (66.4% male) enrolled patients, 299 (21.6%) had the discharge diagnosis of acute myocardial infarction, 184 (13.3%) presented with unstable angina, and in 903 (65.2%) an acute coronary syndrome could be excluded. Combined measurement of copeptin and TnT on admission improved the c-statistic from 0.84 for TnT alone to 0.93 in the overall population and from 0.77 to 0.9 in patients presenting within 3 h after chest pain onset (CPO) (p < 0.001). In this group the combination of copeptin with a conventional TnT provided a negative predictive value of 92.4%. In triage of chest pain patients, determination of copeptin in addition to troponin improves diagnostic performance, especially early after CPO. Combined determination of troponin and copeptin provides a remarkable negative predictive value virtually independent of CPO time and therefore aids in early and safe rule-out of myocardial infarction.

Abstract 5021: Copeptin Improves Early Diagnosis of Acute Myocardial Infarction

Introduction: Early diagnosisof myocardial infarction in chest pain patients is crucial to identify patients at risk and to maintain a fast treatment initiation. Background: Aim of the current investigation is to test whether determination of copeptin, an indirect marker for arginin-vasopressin, adds diagnostic information to conventional troponin in early evaluation of patients with suspected myocardial infarction. Methods: Between 06/2006 and 03/2008 patients with suspected acute coronary syndrome were enrolled consecutively. Copeptin, troponin T, myoglobin and creatine kinase-MB were determined at admission and after 3 and 6 hours. Results: Of 1293 (66.1% male) enrolled patients 244 (18.9%) had the discharge diagnosis of acute myocardial infarction, 211 (16.3%) presented with unstable angina and in 838 (64.8%) patients an acute coronary syndrome could be excluded. Combined measurement of copeptin and troponin T at admission improved the c-statistic from 0.85 for troponin T alone to 0.94 in the overall population and from 0.77 to 0.91 in patients presenting within 3 hours after chest pain onset. In this group the combination provided an excellent negative predictive value of 91.1%. Conclusions: In triage of chest pain patients determination of copeptin in addition to conventional troponin T improves diagnostic performance, especially early after chest pain onset. Combined determination of troponin T and copeptin provides an excellent negative predictive value virtually independent of chest pain onset time and therefore allows an early and safe rule-out of myocardial infarction.

Acute myocardial infarction in chest pain patients with nondiagnostic ECGs: Serial CK-MB sampling in the emergency department

This study tested the hypothesis that serial creatine phosphokinase (CK)-MB sampling in the emergency department can identify acute myocardial infarction (AMI) in patients presenting to the ED with chest pain and nondiagnostic ECGs. Patients more than 30 years old who were evaluated initially in the ED and hospitalized for chest pain were studied. Serial CK-MB levels were analyzed prospectively using a rapid serum immunochemical assay for identification of AMI patients in the ED. Presenting ECGs showing new, greater than 1-mm ST elevation in two or more contiguous leads were considered diagnostic for AMI. All other ECGs were considered nondiagnostic ECGs. CK-MB levels were determined at ED presentation and hourly for three hours (total of four levels). Patients with at least one level of more than 7 ng/mL were considered to have a positive enzyme study. The in-hospital diagnosis of AMI was determined by the development of typical serial ECG changes or separate standard cardiac enzyme changes after admission. Eight tertiary-care medical center hospitals. Of the 616 study patients, 108 (17.5%) were diagnosed in the hospital as AMI; 69 of these AMI patients (63.9%) had nondiagnostic ECGs in the ED. Of the patients with nondiagnostic ECGs, 55 (sensitivity, 79.7%) had a positive ED serial CK-MB enzyme study within three hours after presentation. Combining serial ED CK-MB assay results with diagnostic ECGs yielded an 88.4% sensitivity for AMI detection within three hours of ED presentation. The predictive value of a negative serial ED enzyme study for no AMI was 96.2% (specificity, 93.7%). Serial CK-MB determination in the ED can help identify AMI patients with initial nondiagnostic ECGs. Use of serial CK-MB analysis may facilitate optimal in-hospital disposition and help guide therapeutic interventions in patients with suspected AMI despite a nondiagnostic ECG.