scholarly journals Copeptin as a Prognostic Marker in Acute Chest Pain and Suspected Acute Coronary Syndrome

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Beata Morawiec ◽  
Damian Kawecki ◽  
Brygida Przywara-Chowaniec ◽  
Mariusz Opara ◽  
Piotr Muzyk ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Troponin T ◽  
Strong Predictor ◽  
Acute Chest Pain ◽  
Coronary Syndrome ◽  
Cerebrovascular Events ◽  
Registration Number ◽  
Cox Analysis

Background. In patients admitted with chest pain and suspected acute coronary syndrome (ACS), it is crucial to early identify those who are at higher risk of adverse events. The study aim was to assess the predictive value of copeptin in patients admitted to the emergency department with chest pain and nonconclusive ECG. Methods. Consecutive patients suspected for an ACS were enrolled prospectively. Copeptin and high-sensitive troponin T (hs-TnT) were measured at admission. Patients were followed up at six and 12 months for the occurrence of death and major adverse cardiac and cerebrovascular events (MACCE). Results. Among 154 patients, 11 patients died and 26 experienced MACCE. Mortality was higher in copeptin-positive than copeptin-negative patients with no difference in the rate of MACCE. Copeptin reached the AUC 0.86 (0.75–0.97) for prognosis of mortality at six and 0.77 (0.65–0.88) at 12 months. It was higher than for hs-TnT and their combination at both time points. Copeptin was a strong predictor of mortality in the Cox analysis (HR14.1 at six and HR4.3 at 12 months). Conclusions. Copeptin appears to be an independent predictor of long-term mortality in a selected population of patients suspected for an ACS. The study registration number is ISRCTN14112941.

scholarly journals How Safe Is the Outpatient Management of Patients with Acute Chest Pain and Mildly Increased Cardiac Troponin Concentrations?

2012 ◽  
Vol 58 (5) ◽  
pp. 916-924 ◽  
Author(s):  
Christophe Meune ◽  
Tobias Reichlin ◽  
Affan Irfan ◽  
Nora Schaub ◽  
Raphael Twerenbold ◽  
...  
Keyword(s):  
Chest Pain ◽  
Cardiac Troponin ◽  
Troponin T ◽  
Acute Chest Pain ◽  
High Sensitivity ◽  
Outpatient Management ◽  
Coronary Syndrome ◽  
Risk Patients ◽  
Serial Measurements

Abstract BACKGROUND The appropriate management of patients discharged from the emergency department (ED) with increased high-sensitivity cardiac troponin T (hs-cTnT) but normal or borderline-high conventional cardiac troponin concentrations is unknown. METHODS We investigated 643 consecutive ED patients with acute chest pain who had been discharged for outpatient management after acute myocardial infarction (AMI) had been ruled out by serial measurements of conventional cardiac troponin. hs-cTnT was measured blindly, and we calculated the rates of all-cause mortality (primary endpoint) and subsequent AMI (secondary endpoint) at 30, 90, and 360 days. RESULTS hs-cTnT concentrations were increased (>14 ng/L) in 114 patients (18%) but <30 ng/L in 95% of these patients. Of those 114 patients, 96 (84%) had an adjudicated noncoronary cause of chest pain. Thirty-day mortality (95% CI) was 0.9% (0.1%–6.1%), 90-day mortality was 2.7% (0.9%–8.1%), and 360-day mortality was 5.2% (2.2%–11.9%) in patients with increased hs-cTnT; respective rates (95% CI) of AMI were 0.0%, 1.9% (0.5%–7.2%), and 7.6% (3.7%–15.3%). Increased hs-cTnT was associated with increased mortality and AMI at 90 days (P = 0.006 and P = 0.081, respectively) and 360 days (P = 0.001 for both). CONCLUSIONS hs-cTnT is a strong prognosticator of intermediate and long-term mortality and AMI in low-risk patients discharged from the ED after AMI has been ruled out. The relatively low rate of 30-day events may suggest that patients without acute coronary syndrome and small increases in cardiac troponin are in need of further investigations and treatments, but not necessarily immediate hospitalization.

scholarly journals Is rheumatoid arthritis a risk factor for acute coronary syndrome also among individuals at elevated risk, such as individuals presenting with acute chest pain?

RMD Open ◽  
2020 ◽  
Vol 6 (3) ◽  
pp. e001463
Author(s):  
Per Svensson ◽  
Miriam Bergstrom ◽  
Andrea Discacciati ◽  
Lina Ljung ◽  
Tomas Jernberg ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Acute Coronary Syndrome ◽  
Risk Factor ◽  
Chest Pain ◽  
Troponin T ◽  
Acute Chest Pain ◽  
High Sensitivity ◽  
Coronary Syndrome ◽  
Increased Risk

BackgroundPatients with rheumatoid arthritis (RA) are, on average, at increased risk of acute coronary syndrome (ACS) compared to the general population, but it remains unknown whether RA remains an ACS risk factor also in settings where the ACS risk is already high elevated, such as among individuals presenting to the emergency department (ED) with chest pain.Methods and resultsWe included 49 283 individuals (514 (1.0%) had RA) presenting with chest pain at the four hospital EDs in Stockholm, Sweden, 2013–2016 in a cohort study. Information on exposure (RA), outcome (ACS) and comorbidities was provided through national registers. The association between RA and ACS was assessed, overall and by levels of high-sensitivity cardiac troponin T (hs-cTnT) and number of ACS risk factors, using logistic regression models adjusted for age, sex, hospital, calendar year and cardiovascular risk factors. ACS was more common in patients with (8.2%) than without (4.6%) RA, adjusted OR =1.4, 95% CI 1.0 to 2.0. This association was particularly strong in individuals with initial hs-cTnT levels between 5 and 14 ng/L, or no additional ACS risk factors (adjusted ORs above 2), but no longer detectable in those with hs-cTnT >14 ng/L or with three or more additional ACS risk factors.ConclusionRA is a risk factor for ACS also among patients at the ED with chest pain. This association is not explained by traditional ACS risk factors, and most pronounced in patients with normal hs-cTnT and few other ACS risk factors, prompting particular ACS vigilance in this RA patient group.

The ESC algorithm for serial high-sensitivity troponin T changes and long-term outcomes in patients with suspected acute coronary syndrome

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Pareek ◽  
K.H Kragholm ◽  
J.L Pallisgaard ◽  
C Byrne ◽  
C.J Lee ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Unstable Angina ◽  
Primary Outcome ◽  
Troponin T ◽  
High Sensitivity ◽  
Coronary Syndrome ◽  
Prognostic Implications ◽  
High Sensitivity Troponin T

Abstract Background The fourth universal definition of myocardial infarction (MI) consensus paper suggests that patients with changing troponins not reaching concentrations greater than the 99th percentile may be at high risk and deserve close scrutiny. Purpose To determine long-term prognostic implications of high-sensitivity troponin T (hs-TnT) levels and their relative change (Δ) from baseline in subjects with suspected acute coronary syndrome (ACS). Methods We conducted a retrospective cohort study through individual participant-level linkage between Danish national registries, including subjects with a final discharge diagnosis of acute MI, unstable angina, suspected MI, or chest pain from March 2013 through December 2016 who had a record of at least two serial hs-TnT measurements during hospitalization. Individuals were followed for 12 months, until the occurrence of an event, or censoring due to emigration. Kaplan-Meier analysis and Cox regression, incorporating the competing risk of death, were used to examine the prognostic implications of serial hs-TnT. Subjects were categorized according to whether their first and second hs-TnT were normal/elevated as well as Δhs-TnT and its direction, the latter employing a modified version of the 0/3-hour diagnostic algorithm proposed by ESC, i.e., using cut-offs for Δhs-TnT of 20% and 50%. The primary outcome was a composite of presumed death from cardiovascular causes, recurrent MI, or repeat revascularization (i.e., not including the index event unless the patient died) within 12 months. Results A total of 13,494 individuals (mean age 63.4 years, 39.5% women) were included. Of these, 6129 (45.4%) had a final diagnosis of MI, 941 (7.0%) of unstable angina, and 6414 (47.5%) of either suspected MI or chest pain. Median baseline hs-TnT was 20 ng/l (72.1% elevated), second hs-TnT 27 ng/l (74.6% elevated), Δhs-TnT 4.8%, and time between samples 5.4 hours. At 12 months, 1055 (7.8%) had experienced a primary event. Baseline hs-TnT and Δhs-TnT both displayed a significant association with the primary outcome (P<0.001 for both overall trends and for non-linearity vs. linearity). The Figure shows the prognostic implications of serial hs-TnT. Overall, subjects with two consecutively elevated hs-TnT had the highest 12-month event risk (10.0%), followed by those who went from an elevated to a normal hs-TnT (8.6%), those who went from a normal to an elevated hs-TnT (6.3%), and those with two normal hs-TnT levels (1.6%). The majority either had non-significant Δhs-TnT (−20% to 20%: 56.8%) or a large positive Δhs-TnT (>50%: 30.6%). Individuals with a positive Δhs-TnT (>20%) had a worse prognosis than those without. Conclusions An elevated hs-TnT at any time and Δhs-TnT were both determinants of poorer prognosis in subjects with suspected ACS. Individuals with two normal hs-TnT had a good prognosis, irrespective of their Δhs-TnT. Figure 1 Funding Acknowledgement Type of funding source: None

Chest pain and chest pain units

2018 ◽  
Author(s):  
Eric Durand ◽  
Aurès Chaib ◽  
Etienne Puymirat ◽  
Nicolas Danchin
Keyword(s):  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Acute Coronary Syndromes ◽  
Acute Chest Pain ◽  
The United States ◽  
Cardiac Biomarkers ◽  
Coronary Syndrome ◽  
Cardiology Department ◽  
Coronary Syndromes ◽  
Rule Out

Patients presenting at the emergency department with acute chest pain and suspected to represent an acute coronary syndrome were classically admitted as routine to the cardiology department, resulting in expensive and time-consuming evaluations. However, 2-5% of patients with acute coronary syndromes were discharged home inappropriately, resulting in increased mortality. To address the inability to exclude the diagnosis of acute coronary syndrome, chest pain units were developed, particularly in the United States. These provide an environment where serial electrocardiograms, cardiac biomarkers, and provocative testing can be performed to confirm or rule out an acute coronary syndrome. Eligible candidates include the majority of patients with non-diagnostic electrocardiograms. The results have been impressive; chest pain units have markedly reduced adverse events, while simultaneously increasing the rate of safe discharge by 36%. Despite evidence to suggest that care in chest pain units is more effective for such patients, the percentage of emergency or cardiology departments setting up chest pain units remains low in Europe.

scholarly journals Elevated Heart-Type Fatty Acid-Binding Protein Predicts Early Myocardial Injury and Aids in the Diagnosis of Non-St Elevation Myocardial Infarction

2009 ◽  
Vol 16 (3) ◽  
pp. 141-147 ◽  
Author(s):  
GY Naroo ◽  
S Mohamed Ali ◽  
V Butros ◽  
A Al Haj ◽  
I Mohammed ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Fatty Acid ◽  
Chest Pain ◽  
Fatty Acid Binding Protein ◽  
Troponin T ◽  
Binding Protein ◽  
Fatty Acid Binding ◽  
Coronary Syndrome ◽  
Acid Binding Protein

Background Biomarkers play an important role in the early diagnosis, risk stratification and management of patients with the acute coronary syndrome. Objective The objective of this study was to evaluate the clinical reliability of heart-type fatty acid-binding protein (h-FABP) in identifying patients with the acute coronary syndrome in the early hours of chest pain. Methods Creatine kinase (CK-MB) (in laboratory), troponin T (in laboratory) and h-FABP (with point-of-care test CardioDetect®) were performed on 791 patients who presented with chest pain with duration since onset ranging from 20 minutes to 12 hours. Results Data of the 791 patients were analysed. h-FABP had a higher sensitivity of 75.76% and a specificity of 96.97% compared with 58.59% and 98.84% for troponin T and 68.69% and 97.54% for CK-MB respectively (in the first 6 hours). Conclusion: h-FABP was found to be a better biomarker of cardiac necrosis in the early hours in the diagnosis of non-conclusive ECG in patients with acute myocardial infarction. (Hong Kong j.emerg.med. 2009;16:141–147)

Effect of persistent opium consumption after surgery on the long-term outcomes of surgical revascularisation

2020 ◽  
Vol 27 (18) ◽  
pp. 1996-2003 ◽  
Author(s):  
Farzad Masoudkabir ◽  
Negin Yavari ◽  
Mina Pashang ◽  
Saeed Sadeghian ◽  
Arash Jalali ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Coronary Syndrome ◽  
Cerebrovascular Events

Background A wrong traditional belief persists among people that opium consumption beneficially affects cardiovascular disease and its risk factors. However, no evidence exists regarding the effect of opium consumption or cessation on the long-term risk of major adverse cardio-cerebrovascular events after coronary artery bypass grafting. We therefore aimed to evaluate the effect of persistent opium consumption after surgery on the long-term outcomes of coronary artery bypass grafting. Methods The study population consisted of 28,691 patients (20,924 men, mean age 60.9 years), who underwent coronary artery bypass grafting between 2007 and 2016 at our centre. The patients were stratified into three groups according to the status of opium consumption: never opium consumers ( n = 23,619), persistent postoperative opium consumers ( n = 3636) and enduring postoperative opium withdrawal ( n = 1436). Study endpoints were 5-year mortality and 5-year major adverse cardio-cerebrovascular events, comprising all-cause mortality, acute coronary syndrome, cerebrovascular accident and revascularisation. Results After surgery, 3636 patients continued opium consumption, while 1436 patients persistently avoided opium use. The multivariable survival analysis demonstrated that persistent post-coronary artery bypass grafting opium consumption increased 5-year mortality and 5-year major adverse cardio-cerebrovascular events by 28% (hazard ratio (HR) 1.28, 95% confidence interval (CI) 1.06–1.54; P = 0.009) and 25% (HR 1.25, 95% CI 1.13–1.40; P < 0.0001), respectively. It also increased the 5-year risk of acute coronary syndrome by 34% (sub-distribution HR 1.34, 95% CI 1.16–1.55; P < 0.0001). Conclusions The present data suggest that persistent post-coronary artery bypass grafting opium consumption may significantly increase mortality, major adverse cardio-cerebrovascular events and acute coronary syndrome in the long term. Future studies are needed to confirm our findings.

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