A multicenter comparison of established and emerging cardiac biomarkers for the diagnostic evaluation of chest pain in the emergency department
A multicenter comparison of established and emerging cardiac biomarkers for the diagnostic evaluation of chest pain in the emergency department
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DOI：
10.1016/j.ahj.2011.05.022
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发表时间：
2011-08-01
影响因子：
4.8
通讯作者：
Januzzi, James L., Jr.
中科院分区：
文献类型：
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作者：
Bhardwaj, Anju;Truong, Quynh A.;Januzzi, James L., Jr.
研究背景本研究的目的是评估新的生物标志物在急性冠状动脉综合征（ACS）诊断评估中的作用。方法在318例因急性胸部不适就诊于急诊科的患者中，我们评估了5种候选生物标志物的诊断价值（氨基末端B型利钠肽原[NT-proBNP]，缺血修饰白蛋白，心脏脂肪酸结合蛋白，结果ACS患者62例（19.5%），其中急性心肌梗死（ACS）患者12例（19.5%），急性心肌梗死（ACS）患者12例（19.5%），急性心肌梗死（ACS）患者12例（19.5%）。NT-proBNP（73%、90%）和hsTnI（57%、89%）的敏感性和阴性预测值均高于cTnT（22%、84%）。未结合的游离脂肪酸具有最高的灵敏度（75%），特异性（72%）和阴性预测值（92%）的所有检查的标志物的整体组合。增加NT-proBNP（变化0.09，P = 0.001）、hsTnI（变化0.13，P <0.001）和FFAu（变化0.15，P <0.001）的结果导致cTnT的C统计量显著增加。在综合区分改善和净重新分类改善分析中，NT-proBNP、hsTnI和FFAu为cTnT增加了显著的诊断信息;当将ACS的诊断标准标准变更为hsTnI时，FFAu仍为事件和非事件增加了显著的重新分类。结论在急诊科有ACS症状的患者中，缺血修饰白蛋白和心脏脂肪酸结合蛋白均未检出或排除ACS，而NT-proBNP、hsTnI和FFAu均为cTnT提供了诊断信息。在hsTnI结果的背景下，FFAu测量显著重新分类基线和系列样本中的假阴性和假阳性。(Am Heart J 2011;162：276- 282.
Background The aim of this study is to assess the role of novel biomarkers for the diagnostic evaluation of acute coronary syndrome (ACS).Methods Among 318 patients presenting to an emergency department with acute chest discomfort, we evaluated the diagnostic value of 5 candidate biomarkers (amino terminal pro-B-type natriuretic peptide [NT-proBNP], ischemia modified albumin, heart fatty acid binding protein, high-sensitivity troponin I [hsTnI], and unbound free fatty acids [FFAu]) for detecting ACS, comparing their results with that of conventional troponin T (cTnT).Results Sixty-two subjects (19.5%) had ACS. The sensitivity and negative predictive values of NT-proBNP (73%, 90%) and hsTnI (57%, 89%) were higher than that of cTnT (22%, 84%). Unbound free fatty acids had the highest overall combination of sensitivity (75%), specificity (72%), and negative predictive values (92%) of all the markers examined. A significant increase in the C-statistic for cTnT resulted from the addition of results for NT-proBNP (change 0.09, P = .001), hsTnI (change 0.13, P < .001), and FFAu (change 0.15, P < .001). In integrated discrimination improvement and net reclassification improvement analyses, NT-proBNP, hsTnI, and FFAu added significant diagnostic information to cTnT; when changing the diagnostic criterion standard for ACS to hsTnI, FFAu still added significant reclassification for both events and nonevents. In serial sampling (n = 180), FFAu added important reclassification information to hsTnI.Conclusion Among emergency department patients with symptoms suggestive of ACS, neither ischemia modified albumin nor heart fatty acid binding protein detected or excluded ACS, whereas NT-proBNP, hsTnI, or FFAu added diagnostic information to cTnT. In the context of hsTnI results, FFAu measurement significantly reclassified both false negatives and false positives at baseline and in serial samples. (Am Heart J 2011;162:276-282.e1.)