No Added Value of Novel Biomarkers in the Diagnostic Assessment of Patients Suspected of Acute Coronary Syndrome.

Abstract

BACKGROUND:

Despite the availability of high-sensitive troponin (hs-cTnT), there is still room for improvement in the diagnostic assessment of patients suspected of acute coronary syndrome (ACS). Apart from serial biomarker testing, which is time-consuming, novel biomarkers like copeptin have been proposed to expedite the early diagnosis of suspected ACS in addition to hs-cTnT. We determined whether placenta derived growth factor (PlGF), soluble Fms-like tyrosine kinase 1 (sFlt-1), myoglobin, N-terminal prohormone B-type Natriuretic Peptide (NT-proBNP), growth-differentiation factor 15 (GDF-15) and copeptin improved early assessment of chest pain patients.

METHODS:

This prospective, single centre diagnostic FAME-ER study included patients presenting to the ED with symptoms suggestive of ACS. Blood was collected to measure biomarkers, notably, hs-cTnT was retrospectively assessed. Added value of markers was judged by increase in AUC using multivariable logistic regression.

RESULTS:

Of 453 patients enrolled, 149 (33%) received a final diagnosis of ACS. Hs-cTnT had the highest diagnostic value in both univariable and multivariable analysis. PPVs of the biomarkers ranged from 23.5% (PlGF) to 77.9% (hs-cTnT), NPVs from 67.0% (PlGF) to 86.4% (hs-cTnT). Only myoglobin yielded diagnostic value in addition to clinical symptoms and electrocardiography (ECG) (AUC of clinical model 0.80) with AUC of 0.84 (p<0.001). However, addition of hs-cTnT was superior (AUC 0.89, p<0.001). Addition of the biomarkers to our clinical model and hs-cTnT did not or only marginally (GDF-15) improved diagnostic performance.

CONCLUSION:

When assessing patients suspected of ACS, only myoglobin had added diagnostic value beyond clinical symptoms and ECG. However, when combined with hs-cTnT, it yields no additional diagnostic value. PlGF, sFlt-1, NT-proBNP, GDF-15 and copeptin had no added value to the clinical model or hs-cTnT.

• Authors: Judith M Poldervaart, Emma Röttger, Marieke S Dekker, Nicolaas P A Zuithoff, Peter W H M Verheggen, Evelyn A de Vrey, Thierry X Wildbergh, Arnoud W J van 't Hof, Arend Mosterd, Arno W Hoes
• Journal: PloS one (PLoS One) Vol. 10 Issue 7 Pg. e0132000 ( 2015) ISSN: 1932-6203 [Electronic] United States
• PMID: 26177390 (Publication Type: Journal Article)

Chemical References

• Biomarkers
• GDF15 protein, human
• Glycopeptides
• Growth Differentiation Factor 15
• PGF protein, human
• Peptide Fragments
• Pregnancy Proteins
• Troponin T
• copeptins
• pro-brain natriuretic peptide (1-76)
• Natriuretic Peptide, Brain
• Placenta Growth Factor
• FLT1 protein, human
• Vascular Endothelial Growth Factor Receptor-1

Topics

• Acute Coronary Syndrome (blood, diagnosis)
• Aged
• Area Under Curve
• Biomarkers (blood)
• Electrocardiography
• Female
• Glycopeptides (blood)
• Growth Differentiation Factor 15 (blood)
• Humans
• Logistic Models
• Male
• Middle Aged
• Natriuretic Peptide, Brain (blood)
• Odds Ratio
• Peptide Fragments (blood)
• Placenta Growth Factor
• Pregnancy Proteins (blood)
• Prospective Studies
• ROC Curve
• Sensitivity and Specificity
• Troponin T (blood)
• Vascular Endothelial Growth Factor Receptor-1 (blood)