Diagnostic Performance of a Combination Biomarker Algorithm for Rule-Out of Acute Myocardial Infarction at Time of Presentation to the Emergency Department, Using Heart-Type Fatty Acid-Binding Protein and High-Sensitivity Troponin T tests

Cesar Navarro-Paredes, Mary Jo Kurth, John V Lamont, IB Menown, MW Ruddock, Stephen P Fitzgerald, James McLaughlin

Research output: Contribution to journalArticle

Abstract

Background: Chest pain of suspected cardiac origin is a common complaint for presentation at the emergency department; however only 10% to 13% of patients will have acute myocardial infarction (AMI). This study examined a decision support ‘rule-out’ algorithm to stratify risk of AMI in these patients.
Methods: Five hundred and forty-eight patients with chest-pain of suspected cardiac origin were recruited. Blood samples were collected at presentation (t=0) and after 1, 2, 3, 6, 12 and 24 h. Serum troponin I, heart-type fatty acid bindingprotein (H-FABP), myoglobin, carbonic anhydrase III (CAIII), creatine phosphokinase MB isoenzyme (CKMB)and glycogen phosphorylase isoenzyme BB (GPBB) were measured using the Randox Cardiac Plus Array; Troponin T (cTnT), high sensitivity troponin T (hs-cTnT), high sensitivity CRP (hs-CRP), NT-pro-BNP, total cholesterol, and HDL were measured using a Modular P Analyser. Clinical and demographic information was recorded for each patient.
Results: For biomarker analysis, STEMIs were excluded, leaving 360 patients at presentation (72 NSTEMI and 288 non-AMI) and 320 patients at 1 h (66 NSTEMI and 254 non-AMI). A rule-out algorithm was developed based onH-FABP and hs-cTnT. When the H-FABP hs-cTnT combination algorithm was applied to the data, 106 additional patients at presentation were identified as non-AMI compared to the standard ESC algorithm, 189/288 (65.6%) vs.83/288 (28.8%) (p<0.0005), respectively. Furthermore, the H-FABP hs-cTnT combination algorithm, identified 71% of non-AMI patients at 1 hour with no false negatives.
Conclusion: Deployment of the H-FABP hs-cTnT combination algorithm at the emergency department could assist in the identification of non-AMI patients at presentation with the potential to reduce the number of hospital admissions by 106/288 (36.8%). Using the H-FABP hs-cTnT combination algorithm would have a significant impact on patient health ensuring that the appropriate care and efficient use of resources are directed to patients identified as high risk.
LanguageEnglish
Article number1000600
Pages1-9
Number of pages9
JournalJournal of Clinical and Experimental Cardiology
Volume9
Issue number8
DOIs
Publication statusPublished - 11 Aug 2018

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Fatty Acid-Binding Proteins
Troponin T
Hospital Emergency Service
Biomarkers
Myocardial Infarction
Fatty Acids
Chest Pain
Isoenzymes
Carbonic Anhydrase III
Glycogen Phosphorylase
Troponin I
Myoglobin
Creatine Kinase
HDL Cholesterol
Demography

Keywords

  • H-FABP
  • Hs-cTnT
  • AMI
  • Rule-out
  • Algorithm
  • Emergency Department

Cite this

@article{dee78c19c57c44598cb43c0bab525103,
title = "Diagnostic Performance of a Combination Biomarker Algorithm for Rule-Out of Acute Myocardial Infarction at Time of Presentation to the Emergency Department, Using Heart-Type Fatty Acid-Binding Protein and High-Sensitivity Troponin T tests",
abstract = "Background: Chest pain of suspected cardiac origin is a common complaint for presentation at the emergency department; however only 10{\%} to 13{\%} of patients will have acute myocardial infarction (AMI). This study examined a decision support ‘rule-out’ algorithm to stratify risk of AMI in these patients.Methods: Five hundred and forty-eight patients with chest-pain of suspected cardiac origin were recruited. Blood samples were collected at presentation (t=0) and after 1, 2, 3, 6, 12 and 24 h. Serum troponin I, heart-type fatty acid bindingprotein (H-FABP), myoglobin, carbonic anhydrase III (CAIII), creatine phosphokinase MB isoenzyme (CKMB)and glycogen phosphorylase isoenzyme BB (GPBB) were measured using the Randox Cardiac Plus Array; Troponin T (cTnT), high sensitivity troponin T (hs-cTnT), high sensitivity CRP (hs-CRP), NT-pro-BNP, total cholesterol, and HDL were measured using a Modular P Analyser. Clinical and demographic information was recorded for each patient.Results: For biomarker analysis, STEMIs were excluded, leaving 360 patients at presentation (72 NSTEMI and 288 non-AMI) and 320 patients at 1 h (66 NSTEMI and 254 non-AMI). A rule-out algorithm was developed based onH-FABP and hs-cTnT. When the H-FABP hs-cTnT combination algorithm was applied to the data, 106 additional patients at presentation were identified as non-AMI compared to the standard ESC algorithm, 189/288 (65.6{\%}) vs.83/288 (28.8{\%}) (p<0.0005), respectively. Furthermore, the H-FABP hs-cTnT combination algorithm, identified 71{\%} of non-AMI patients at 1 hour with no false negatives.Conclusion: Deployment of the H-FABP hs-cTnT combination algorithm at the emergency department could assist in the identification of non-AMI patients at presentation with the potential to reduce the number of hospital admissions by 106/288 (36.8{\%}). Using the H-FABP hs-cTnT combination algorithm would have a significant impact on patient health ensuring that the appropriate care and efficient use of resources are directed to patients identified as high risk.",
keywords = "H-FABP, Hs-cTnT, AMI, Rule-out, Algorithm, Emergency Department",
author = "Cesar Navarro-Paredes and Kurth, {Mary Jo} and Lamont, {John V} and IB Menown and MW Ruddock and Fitzgerald, {Stephen P} and James McLaughlin",
year = "2018",
month = "8",
day = "11",
doi = "10.4172/2155-9880.1000600",
language = "English",
volume = "9",
pages = "1--9",
journal = "Journal of Clinical and Experimental Cardiology",
issn = "2155-9880",
number = "8",

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TY - JOUR

T1 - Diagnostic Performance of a Combination Biomarker Algorithm for Rule-Out of Acute Myocardial Infarction at Time of Presentation to the Emergency Department, Using Heart-Type Fatty Acid-Binding Protein and High-Sensitivity Troponin T tests

AU - Navarro-Paredes, Cesar

AU - Kurth, Mary Jo

AU - Lamont, John V

AU - Menown, IB

AU - Ruddock, MW

AU - Fitzgerald, Stephen P

AU - McLaughlin, James

PY - 2018/8/11

Y1 - 2018/8/11

N2 - Background: Chest pain of suspected cardiac origin is a common complaint for presentation at the emergency department; however only 10% to 13% of patients will have acute myocardial infarction (AMI). This study examined a decision support ‘rule-out’ algorithm to stratify risk of AMI in these patients.Methods: Five hundred and forty-eight patients with chest-pain of suspected cardiac origin were recruited. Blood samples were collected at presentation (t=0) and after 1, 2, 3, 6, 12 and 24 h. Serum troponin I, heart-type fatty acid bindingprotein (H-FABP), myoglobin, carbonic anhydrase III (CAIII), creatine phosphokinase MB isoenzyme (CKMB)and glycogen phosphorylase isoenzyme BB (GPBB) were measured using the Randox Cardiac Plus Array; Troponin T (cTnT), high sensitivity troponin T (hs-cTnT), high sensitivity CRP (hs-CRP), NT-pro-BNP, total cholesterol, and HDL were measured using a Modular P Analyser. Clinical and demographic information was recorded for each patient.Results: For biomarker analysis, STEMIs were excluded, leaving 360 patients at presentation (72 NSTEMI and 288 non-AMI) and 320 patients at 1 h (66 NSTEMI and 254 non-AMI). A rule-out algorithm was developed based onH-FABP and hs-cTnT. When the H-FABP hs-cTnT combination algorithm was applied to the data, 106 additional patients at presentation were identified as non-AMI compared to the standard ESC algorithm, 189/288 (65.6%) vs.83/288 (28.8%) (p<0.0005), respectively. Furthermore, the H-FABP hs-cTnT combination algorithm, identified 71% of non-AMI patients at 1 hour with no false negatives.Conclusion: Deployment of the H-FABP hs-cTnT combination algorithm at the emergency department could assist in the identification of non-AMI patients at presentation with the potential to reduce the number of hospital admissions by 106/288 (36.8%). Using the H-FABP hs-cTnT combination algorithm would have a significant impact on patient health ensuring that the appropriate care and efficient use of resources are directed to patients identified as high risk.

AB - Background: Chest pain of suspected cardiac origin is a common complaint for presentation at the emergency department; however only 10% to 13% of patients will have acute myocardial infarction (AMI). This study examined a decision support ‘rule-out’ algorithm to stratify risk of AMI in these patients.Methods: Five hundred and forty-eight patients with chest-pain of suspected cardiac origin were recruited. Blood samples were collected at presentation (t=0) and after 1, 2, 3, 6, 12 and 24 h. Serum troponin I, heart-type fatty acid bindingprotein (H-FABP), myoglobin, carbonic anhydrase III (CAIII), creatine phosphokinase MB isoenzyme (CKMB)and glycogen phosphorylase isoenzyme BB (GPBB) were measured using the Randox Cardiac Plus Array; Troponin T (cTnT), high sensitivity troponin T (hs-cTnT), high sensitivity CRP (hs-CRP), NT-pro-BNP, total cholesterol, and HDL were measured using a Modular P Analyser. Clinical and demographic information was recorded for each patient.Results: For biomarker analysis, STEMIs were excluded, leaving 360 patients at presentation (72 NSTEMI and 288 non-AMI) and 320 patients at 1 h (66 NSTEMI and 254 non-AMI). A rule-out algorithm was developed based onH-FABP and hs-cTnT. When the H-FABP hs-cTnT combination algorithm was applied to the data, 106 additional patients at presentation were identified as non-AMI compared to the standard ESC algorithm, 189/288 (65.6%) vs.83/288 (28.8%) (p<0.0005), respectively. Furthermore, the H-FABP hs-cTnT combination algorithm, identified 71% of non-AMI patients at 1 hour with no false negatives.Conclusion: Deployment of the H-FABP hs-cTnT combination algorithm at the emergency department could assist in the identification of non-AMI patients at presentation with the potential to reduce the number of hospital admissions by 106/288 (36.8%). Using the H-FABP hs-cTnT combination algorithm would have a significant impact on patient health ensuring that the appropriate care and efficient use of resources are directed to patients identified as high risk.

KW - H-FABP

KW - Hs-cTnT

KW - AMI

KW - Rule-out

KW - Algorithm

KW - Emergency Department

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DO - 10.4172/2155-9880.1000600

M3 - Article

VL - 9

SP - 1

EP - 9

JO - Journal of Clinical and Experimental Cardiology

T2 - Journal of Clinical and Experimental Cardiology

JF - Journal of Clinical and Experimental Cardiology

SN - 2155-9880

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M1 - 1000600

ER -