Abstract | BACKGROUND: METHODS: RESULTS: Patients with ACS (n = 29, 9%) had higher concentrations of each biomarker compared to those without (all P < .01). Adding natriuretic peptides, especially N-terminal pro- B type natriuretic peptide, to both cTnT or hsTnT improved the C-statistics and net reclassification index for ACS, largely driven by correctly reclassifying events. Dual-negative marker results improved sensitivity (cTnT 38% to 83%-86%, hsTnT 59% to 86%-90%; all P < .01) and negative predictive value (cTnT 94% to 97%-98%, hsTnT 96% to 97%-98%) for ACS. Patients with dual-negative markers had the lowest percentage of CT coronary plaque, stenosis, and regional wall motion abnormality (all P-trend <.001). CONCLUSION: Among emergency department patients with low-intermediate likelihood of ACS, combining natriuretic peptides with either conventional or highly-sensitive troponin improved discriminatory capacity and allowed for better reclassification of ACS, findings supported by structural and functional CT results.
|
Authors | Quynh A Truong, James Bayley, Udo Hoffmann, Fabian Bamberg, Christopher L Schlett, John T Nagurney, Wolfgang Koenig, James L Januzzi |
Journal | American heart journal
(Am Heart J)
Vol. 163
Issue 6
Pg. 972-979.e1
(Jun 2012)
ISSN: 1097-6744 [Electronic] United States |
PMID | 22709749
(Publication Type: Journal Article)
|
Copyright | Copyright © 2012 Mosby, Inc. All rights reserved. |
Chemical References |
- Biomarkers
- Natriuretic Peptides
- Peptide Fragments
- Troponin T
- midregional pro-atrial natriuretic peptide, human
- pro-brain natriuretic peptide (1-76)
- Natriuretic Peptide, Brain
- Atrial Natriuretic Factor
|
Topics |
- Acute Coronary Syndrome
(diagnosis)
- Adult
- Atrial Natriuretic Factor
(blood)
- Biomarkers
(blood)
- Chest Pain
(etiology)
- Emergency Service, Hospital
- Female
- Humans
- Male
- Middle Aged
- Myocardial Infarction
(diagnostic imaging)
- Natriuretic Peptide, Brain
(blood)
- Natriuretic Peptides
(blood)
- Peptide Fragments
(blood)
- Sensitivity and Specificity
- Tomography, X-Ray Computed
- Troponin T
(blood)
|