Different characteristics of cardiac biomarkers to decide and predict the culprit lesions in patients with suspicious acute coronary syndrome.

Abstract

This multicenter prospective study was conducted to assess high-sensitivity troponin T (hs-TnT) and other biomarkers to decide and predict culprit lesions indicated for emergency percutaneous coronary intervention (PCI) in patients with suspicious acute coronary syndrome (ACS). We have reported Hs-TnT is the most sensitive biomarker for earlier diagnosis and decision making in patients with suspected ACS. In this study, we had conducted subanalysis investigating the usefulness for prediction of ACS culprit lesion. The patients with suspicious ACS and initially negative whole-blood rapid troponin T test, who underwent coronary angiogram (CAG), were enrolled (n = 74). Hs-TnT, quantitative assay for conventional troponin T (c-TnT), creatine kinase MB isozyme (CK-MB), and heart-type fatty acid-binding protein (H-FABP) were simultaneously measured. ACS culprit lesion was described as total occlusion, subtotal occlusion, and/or angiographical unstable lesion such as thrombosis, ulceration or irregularity. The CAG revealed that 49 cases had ACS lesions to be indicated for emergency PCI. The areas under the ROC curves and ROC-optimized cut-off of hs-TnT, c-TnT, CK-MB, and H-FABP were 0.75, 0.67, 0.68, and 0.75, respectively, and 18, 11, 2.0, and 4.6 ng/ml, respectively. In patients with total occlusion and 90-99 % of diameter stenosis (TIMI 2 or 3), hs-TnT could predict emergency PCI with significantly higher sensitivity compared with H-FABP (hs-TnT >14 ng/ml; 71 %, and H-FABP >6.2 ng/dl; 51 %, p = 0.021) and other biomarkers. Meanwhile, H-FABP displayed significant correlations with number of diseased vessels and presence of thrombotic lesion. The present study first revealed different characteristics of correlation between the angiographic culprit lesions and each cardiac biomarker. For prediction of ACS lesions requiring emergency PCI, hs-TnT had the highest sensitivity with satisfied analytical precision.

• Authors: Mitsunobu Kitamura, Noritake Hata, Tadateru Takayama, Atsushi Hirayama, Masashi Ogawa, Akira Yamashina, Hisaaki Mera, Hideaki Yoshino, Fumitaka Nakamura, Yoshihiko Seino
• Journal: Heart and vessels (Heart Vessels) Vol. 31 Issue 6 Pg. 907-17 (Jun 2016) ISSN: 1615-2573 [Electronic] Japan
• PMID: 26081026 (Publication Type: Comparative Study, Journal Article, Multicenter Study)

Chemical References

• Biomarkers
• FABP3 protein, human
• Fatty Acid Binding Protein 3
• Fatty Acid-Binding Proteins
• Troponin T
• Creatine Kinase, MB Form

Topics

• Acute Coronary Syndrome (blood, diagnostic imaging, therapy)
• Aged
• Area Under Curve
• Biomarkers (blood)
• Coronary Angiography
• Coronary Vessels (diagnostic imaging)
• Creatine Kinase, MB Form (blood)
• Decision Support Techniques
• Early Diagnosis
• Emergencies
• Fatty Acid Binding Protein 3
• Fatty Acid-Binding Proteins (blood)
• Female
• Humans
• Male
• Percutaneous Coronary Intervention
• Predictive Value of Tests
• Prospective Studies
• ROC Curve
• Tokyo
• Troponin T (blood)
• Up-Regulation