Comparison of the clinical chemistry score to other biomarker algorithms for rapid rule-out of acute myocardial infarction and risk stratification in patients with suspected acute coronary syndrome

• Verfasst von: Yildirim, Mustafa [VerfasserIn]
• Verfasst von: Salbach, Christian [VerfasserIn]
• Verfasst von: Reich, Christoph [VerfasserIn]
• Verfasst von: Milles, Barbara Ruth [VerfasserIn]
• Verfasst von: Biener, Moritz [VerfasserIn]
• Verfasst von: Frey, Norbert [VerfasserIn]
• Verfasst von: Giannitsis, Evangelos [VerfasserIn]
• Verfasst von: Müller-Hennessen, Matthias [VerfasserIn]
• Titel: Comparison of the clinical chemistry score to other biomarker algorithms for rapid rule-out of acute myocardial infarction and risk stratification in patients with suspected acute coronary syndrome
• Verf.angabe: Mustafa Yildirim, Christian Salbach, Christoph Reich, Barbara Ruth Milles, Moritz Biener, Norbert Frey, Evangelos Giannitsis, Matthias Mueller-Hennessen
• E-Jahr: 2024
• Jahr: 1 April 2024
• Umfang: 7 S.
• Fussnoten: Online verfügbar: 24 January 2024, Artikelversion 19 February 2024 ; Gesehen am 13.09.2024
• Titel Quelle: Enthalten in: International journal of cardiology
• Ort Quelle: Amsterdam [u.a.] : Elsevier Science, 1981
• Jahr Quelle: 2024
• Band/Heft Quelle: 400(2024) vom: Apr., Artikel-ID 131815, Seite 1-7
• ISSN Quelle: 1874-1754
• DOI: doi:10.1016/j.ijcard.2024.131815
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: Acute coronary syndrome
• Sach-SW: Cardiac troponin
• Sach-SW: Clinical chemistry score
• Sach-SW: Copeptin
• Sach-SW: Emergency department
• Sach-SW: High-sensitivity
• K10plus-PPN: 1902477847

Abstract

Background - The clinical chemistry score (CCS) comprising high-sensitivity cardiac troponins (hs-cTn), glucose and estimated glomerular filtration rate has been previously validated with superior accuracy for detection and risk stratification of acute myocardial infarction (AMI) compared to hs-cTn alone. - Methods - The CCS was compared to other biomarker-based algorithms for rapid rule-out and prognostication of AMI including the hs-cTnT limit-of-blank (LOB, <3 ng/L) or limit-of-detection (LOD, <5 ng/L) and a dual marker strategy (DMS) (copeptin <10 pmol/L and hs-cTnT ≤14 ng/L) in 1506 emergency department (ED) patients with symptoms suggestive of acute coronary syndrome. Negative predictive values (NPV) and sensitivities for AMI rule-out, and 12-month combined endpoint rates encompassing mortality, myocardial re-infarction, as well as stroke were assessed. - Results - NPVs of 100% (95% CI: 98.3-100%) were observed for CCS = 0, hs-cTnT LoB and hs-cTnT LoD with rule-out efficacies of 11.1%, 7.6% and 18.3% as well as specificities of 13.0% (95% CI: 9.9-16.6%), 8.8% (95% CI: 7.3-10.5%) and 21.4% (95% CI: 19.2-23.8%), respectively. A CCS ≤ 1 achieved a rule-out in 32.2% of all patients with a NPV of 99.6% (95% CI: 98.4-99.9%) and specificity of 37.4% (95% CI: 34.2-40.5%) compared to a rule-out efficacy of 51.2%, NPV of 99.0 (95% CI: 98.0-99.5) and specificity of 59.7% (95% CI: 57.0-62.4%) for the DMS. Rates of the combined end-point of death/AMI within 30 days ranged between 0.0% and 0.7% for all fast-rule-out protocols. - Conclusions - The CCS ensures reliable AMI rule-out with low short and long-term outcome rates for a specific ED patient subset. However, compared to a single or dual biomarker strategy, the CCS displays reduced efficacy and specificity, limiting its clinical utility.