Comparison of two biomarker only algorithms for early risk stratification in patients with suspected acute coronary syndrome

INTERNATIONAL JOURNAL OF CARDIOLOGY

卷:319

Article

Kavsak, Peter A.¹  Mondoux, Shawn E.²  Ma, Jinhui³  Sherbino, Jonathan²  Hill, Stephen A.¹  Clayton, Natasha⁴  Mehta, Shamir R.⁵  Griffith, Lauren E.³  McQueen, Matthew¹  Devereaux, P. J.⁵  Worster, Andrew² 

[1] McMaster Univ, Dept Pathol & Mol Med, Hamilton, ON, Canada

[2] McMaster Univ, Div Emergency Med, Hamilton, ON, Canada

[3] McMaster Univ, Dept Hlth Res Methods Evidence & Impact, Hamilton, ON, Canada

[4] McMaster Univ, Dept Med, Hamilton, ON, Canada

[5] McMaster Univ, Populat Hlth Res Inst, Div Cardiol, Hamilton, ON, Canada

关键词: High-sensitivity cardiac troponin;    Glucose;    eGRF;    Acute coronary syndrome;    Emergency department;    Myocardial infarction;    Cardiovascular death;   

DOI  :  10.1016/j.ijcard.2020.06.066

来源: Elsevier

【 摘 要 】

Background: We developed a biomarker algorithm encompassing the clinical chemistry score (CCS; which includes the combination of a random glucose concentration, an estimated glomerular filtration rate and high-sensitivity cardiac troponin; hs-cTn) with the Ortho Clinical Diagnostics hs-cTnI assay (CCS-serial) and compared it to the cutoffs derived from Ortho Clinical Diagnostics 0/1 h (h) algorithm for 7-daymyocardial infarction (MI) or cardiovascular (CV)-death. Methods: The study cohort was an emergency department (ED) population (n=906) with symptoms suggestive of acute coronary syndrome (ACS) who had two Ortho hs-cTnI results approximately 3 h apart. Diagnostic parameters (sensitivity/specificity/negative predictive value; NPV/positive predictive value; PPV) were derived for the CCS-serial and the 0/1 h algorithm for 7-day MI/CV-death. A safety analysis was performed for patients in the rule-out arms of the algorithms for 30-day MI/death. Results: The CCS-serial algorithmyielded 100% sensitivity/NPV (32% low-risk) and 95.7% specificity/65% PPV (11% high-risk). The 0/1 h algorithm-cutoffs yielded sensitivity/NPV/specificity/PPV of 97.8%/99.4%/91.3%/50%, which classified 38% of patients as low-risk and 16% of patients as high-risk. Four patients (1.2%) in the 0/1 h algorithm-cutoff rule-out arm had a 30-dayMI/death outcome as compared to zero patients in the CCS-serial rule-out arm (p = 0.06). Conclusion: Both the CCS-serial and 0/1 h algorithm cutoffs yield high NPVs with a similar proportion of patients identified as low-risk. These data may be useful for sites who are unable to collect samples at 0/1 h in the emergency department. (C) 2020 The Author(s). Published by Elsevier B.V.

【 授权许可】

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