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Alkaiyat A, Abumadi R, Atari S, Sayeh W, Al Zabadi H, Sarawan Z, Bisharat F, Shakhshir N. Interventional cardiac catheterization predictors at Al-Arabi heart Center in Palestine in 2017. BMC Cardiovasc Disord 2019; 19:237. [PMID: 31660865 PMCID: PMC6816186 DOI: 10.1186/s12872-019-1222-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 10/10/2019] [Indexed: 11/17/2022] Open
Abstract
Background Cardiac catheterization is performed for both therapeutic and diagnostic reasons, in which the outcome may vary from only medical treatment to the need of percutaneous coronary intervention and ending with coronary artery bypass graft. The primary goal of this study was to determine predictors of revascularization. Methods A retrospective cohort study was conducted on data collected from records of patients who underwent cardiac catheterization at Al-Arabi Heart Center in Palestine in 2017. Multivariate logistic regression analysis was carried out to assess the association of sociodemographic and pre-catheterization clinical predictors with revascularization. Results A total of 1550 patients were included in the study. The participants mean age was 58 with a SD of 11.7 years, 73.6% were males. 50.2% of patients who underwent an interventional cardiac catheterization tested negative for troponin on presentation. Multivariate logistic regression showed Troponin (RR = 4.5), Age (RR = 1.0), Female gender (RR = 0.4) previous catheterization (RR = 2.0), and existence of diabetes as significant predictors for revascularization. The correlation between ECG on presentation and the subsequent need for an interventional cardiac catheterization was significant only in case of ST-Elevation (RR = 1.5), and T wave inversion (RR = 1.6). CK-MB, Hypertension and ECG with ST-depression were not significant predictors. Conclusion This study assessed revascularization predictors in addition to characteristics and outcomes of patients who have undergone cardiac catheterization. The results showed the especially high predictive value of troponin in determining the need for revascularization which outweighed the importance of ECG findings on presentation in making clinical decision regarding catheterization.
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Affiliation(s)
- Abdulsalam Alkaiyat
- Faculty of Medicine and Health Sciences, An-Najah National University, P. O. Box 7, Nablus, Palestine. .,Swiss Tropical and Public Health Institute, University of Basel, Socinstrasse 57, 4002, Basel, Switzerland. .,Specialized Arab Hospital, Nablus, Palestine.
| | - Reham Abumadi
- Faculty of Medicine and Health Sciences, An-Najah National University, P. O. Box 7, Nablus, Palestine
| | - Shuruq Atari
- Faculty of Medicine and Health Sciences, An-Najah National University, P. O. Box 7, Nablus, Palestine
| | - Wasef Sayeh
- Faculty of Medicine and Health Sciences, An-Najah National University, P. O. Box 7, Nablus, Palestine
| | - Hamzeh Al Zabadi
- Faculty of Medicine and Health Sciences, An-Najah National University, P. O. Box 7, Nablus, Palestine.,Joint MD Program, Palestine Polytechnic University, Hebron, Palestine
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Scherzer R, Shah SJ, Secemsky E, Butler J, Grunfeld C, Shlipak MG, Hsue PY. Association of Biomarker Clusters With Cardiac Phenotypes and Mortality in Patients With HIV Infection. Circ Heart Fail 2019; 11:e004312. [PMID: 29615435 PMCID: PMC5886751 DOI: 10.1161/circheartfailure.117.004312] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 03/01/2018] [Indexed: 12/04/2022]
Abstract
Supplemental Digital Content is available in the text. Background: Although individual cardiac biomarkers are associated with heart failure risk and all-cause mortality in HIV-infected individuals, their combined use for prediction has not been well studied. Methods and Results: Unsupervised k-means cluster analysis was performed blinded to the study outcomes in 332 HIV-infected participants on 8 biomarkers: ST2, NT-proBNP (N-terminal pro-B-type natriuretic peptide), hsCRP (high-sensitivity C-reactive protein), GDF-15 (growth differentiation factor 15), cystatin C, IL-6 (interleukin-6), D-dimer, and troponin. We evaluated cross-sectional associations of each cluster with diastolic dysfunction, pulmonary hypertension (defined as echocardiographic pulmonary artery systolic pressure ≥35 mm Hg), and longitudinal associations with all-cause mortality. The biomarker-derived clusters partitioned subjects into 3 groups. Cluster 3 (n=103) had higher levels of CRP, IL-6, and D-dimer (inflammatory phenotype). Cluster 2 (n=86) displayed elevated levels of ST2, NT-proBNP, and GDF-15 (cardiac phenotype). Cluster 1 (n=143) had lower levels of both phenotype-associated biomarkers. After multivariable adjustment for traditional and HIV-related risk factors, cluster 3 was associated with a 51% increased risk of diastolic dysfunction (95% confidence interval, 1.12–2.02), and cluster 2 was associated with a 67% increased risk of pulmonary hypertension (95% confidence interval, 1.04–2.68), relative to cluster 1. Over a median 6.9-year follow-up, 48 deaths occurred. Cluster 3 was independently associated with a 3.3-fold higher risk of mortality relative to cluster 1 (95% confidence interval, 1.3–8.1), and cluster 2 had a 3.1-fold increased risk (95% confidence interval, 1.1–8.4), even after controlling for diastolic dysfunction, pulmonary hypertension, left ventricular mass, and ejection fraction. Conclusions: Serum biomarkers can be used to classify HIV-infected individuals into separate clusters for differentiating cardiopulmonary structural and functional abnormalities and can predict mortality independent of these structural and functional measures.
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Affiliation(s)
- Rebecca Scherzer
- Department of Medicine, University of California, San Francisco and Veterans Affairs Medical Center, San Francisco (R.S., C.G., M.G.S.). Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.). Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA (E.S.). Division of Cardiology, Department of Medicine, Stony Brook University, NY (J.B.). Department of Medicine, San Francisco General Hospital, University of California, San Francisco (P.Y.H.)
| | - Sanjiv J Shah
- Department of Medicine, University of California, San Francisco and Veterans Affairs Medical Center, San Francisco (R.S., C.G., M.G.S.). Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.). Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA (E.S.). Division of Cardiology, Department of Medicine, Stony Brook University, NY (J.B.). Department of Medicine, San Francisco General Hospital, University of California, San Francisco (P.Y.H.)
| | - Eric Secemsky
- Department of Medicine, University of California, San Francisco and Veterans Affairs Medical Center, San Francisco (R.S., C.G., M.G.S.). Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.). Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA (E.S.). Division of Cardiology, Department of Medicine, Stony Brook University, NY (J.B.). Department of Medicine, San Francisco General Hospital, University of California, San Francisco (P.Y.H.)
| | - Javed Butler
- Department of Medicine, University of California, San Francisco and Veterans Affairs Medical Center, San Francisco (R.S., C.G., M.G.S.). Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.). Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA (E.S.). Division of Cardiology, Department of Medicine, Stony Brook University, NY (J.B.). Department of Medicine, San Francisco General Hospital, University of California, San Francisco (P.Y.H.)
| | - Carl Grunfeld
- Department of Medicine, University of California, San Francisco and Veterans Affairs Medical Center, San Francisco (R.S., C.G., M.G.S.). Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.). Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA (E.S.). Division of Cardiology, Department of Medicine, Stony Brook University, NY (J.B.). Department of Medicine, San Francisco General Hospital, University of California, San Francisco (P.Y.H.)
| | - Michael G Shlipak
- Department of Medicine, University of California, San Francisco and Veterans Affairs Medical Center, San Francisco (R.S., C.G., M.G.S.). Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.). Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA (E.S.). Division of Cardiology, Department of Medicine, Stony Brook University, NY (J.B.). Department of Medicine, San Francisco General Hospital, University of California, San Francisco (P.Y.H.)
| | - Priscilla Y Hsue
- Department of Medicine, University of California, San Francisco and Veterans Affairs Medical Center, San Francisco (R.S., C.G., M.G.S.). Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.). Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA (E.S.). Division of Cardiology, Department of Medicine, Stony Brook University, NY (J.B.). Department of Medicine, San Francisco General Hospital, University of California, San Francisco (P.Y.H.).
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Trost J, Feldman L. Creatine kinase-myocardial band for chest pain and suspected acute coronary syndrome. J Hosp Med 2015; 10:827-9. [PMID: 26769081 DOI: 10.1002/jhm.2384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 03/26/2015] [Accepted: 04/28/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Jeff Trost
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Leonard Feldman
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Discordant creatine kinase and cardiac troponin T in the workup of acute coronary syndrome. CAN J EMERG MED 2015; 12:64-8. [DOI: 10.1017/s1481803500012069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ABSTRACT
A 55-year-old man presented to the emergency department (ED) following 2 episodes of typical cardiac chest pain and nonspecific electrocardiogram findings. His serial cardiac marker assays revealed an elevated total creatine kinase (CK) and 2 negative cardiac troponin levels. Because of a high clinical suspicion of acute coronary syndrome, a total creatine kinase MB mass was obtained and found to be elevated. Subsequent cardiac angiography demonstrated a significantly flow-limiting coronary artery lesion, and stenting was performed. This case demonstrates that simultaneous CK and troponin measurements may have utility in selected ED patients with chest pain. The interpretation of discordant CK and troponin levels is discussed.
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Amsterdam EA, Wenger NK, Brindis RG, Casey DE, Ganiats TG, Holmes DR, Jaffe AS, Jneid H, Kelly RF, Kontos MC, Levine GN, Liebson PR, Mukherjee D, Peterson ED, Sabatine MS, Smalling RW, Zieman SJ. 2014 AHA/ACC Guideline for the Management of Patients with Non-ST-Elevation Acute Coronary Syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014; 64:e139-e228. [PMID: 25260718 DOI: 10.1016/j.jacc.2014.09.017] [Citation(s) in RCA: 2089] [Impact Index Per Article: 208.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Amsterdam EA, Wenger NK, Brindis RG, Casey DE, Ganiats TG, Holmes DR, Jaffe AS, Jneid H, Kelly RF, Kontos MC, Levine GN, Liebson PR, Mukherjee D, Peterson ED, Sabatine MS, Smalling RW, Zieman SJ. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2014; 130:e344-426. [PMID: 25249585 DOI: 10.1161/cir.0000000000000134] [Citation(s) in RCA: 636] [Impact Index Per Article: 63.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Miller CS, Foley JD, Floriano PN, Christodoulides N, Ebersole JL, Campbell CL, Bailey AL, Rose BG, Kinane DF, Novak MJ, McDevitt JT, Ding X, Kryscio RJ. Utility of salivary biomarkers for demonstrating acute myocardial infarction. J Dent Res 2014; 93:72S-79S. [PMID: 24879575 DOI: 10.1177/0022034514537522] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
The comparative utility of serum and saliva as diagnostic fluids for identifying biomarkers of acute myocardial infarction (AMI) was investigated. The goal was to determine if salivary biomarkers could facilitate a screening diagnosis of AMI, especially in cases of non-ST elevation MI (NSTEMI), since these cases are not readily identified by electrocardiogram (ECG). Serum and unstimulated whole saliva (UWS) collected from 92 AMI patients within 48 hours of chest pain onset and 105 asymptomatic healthy control individuals were assayed for 13 proteins relevant to cardiovascular disease, by Beadlyte technology (Luminex(®)) and enzyme immunoassays. Data were analyzed with concentration cut-points, ECG findings, logistic regression (LR) (adjusted for matching for age, gender, race, smoking, number of teeth, and oral health status), and classification and regression tree (CART) analysis. A sensitivity analysis was conducted by repetition of the CART analysis in 58 cases and 58 controls, each matched by age and gender. Serum biomarkers demonstrated AMI sensitivity and specificity superior to that of saliva, as determined by LR and CART. The predominant discriminators in serum by LR were troponin I (TnI), B-type natriuretic peptide (BNP), and creatine kinase-MB (CK-MB), and TnI and BNP by CART. In saliva, LR identified C-reactive protein (CRP) as the biomarker most predictive of AMI. A combination of smoking tobacco, UWS CRP, CK-MB, sCD40 ligand, gender, and number of teeth identified AMI in the CART decision trees. When ECG findings, salivary biomarkers, and confounders were included, AMI was predicted with 80.0% sensitivity and 100% specificity. These analyses support the potential utility of salivary biomarker measurements used with ECG for the identification of AMI. Thus, saliva-based tests may provide additional diagnostic screening information in the clinical course for patients suspected of having an AMI.
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Affiliation(s)
- C S Miller
- Department of Oral Health Practice, Center for Oral Health Research, College of Dentistry, University of Kentucky, Lexington, KY, USA
| | - J D Foley
- Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, KY, USA
| | - P N Floriano
- Department of Bioengineering and Chemistry, Rice University, Houston, TX, USA
| | - N Christodoulides
- Department of Bioengineering and Chemistry, Rice University, Houston, TX, USA
| | - J L Ebersole
- Department of Oral Health Practice, Center for Oral Health Research, College of Dentistry, University of Kentucky, Lexington, KY, USA
| | - C L Campbell
- Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, KY, USA
| | - A L Bailey
- Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, KY, USA
| | - B G Rose
- School of Dentistry, University of Louisville, Louisville, KY, USA
| | - D F Kinane
- School of Dentistry, University of Louisville, Louisville, KY, USA
| | - M J Novak
- Department of Oral Health Practice, Center for Oral Health Research, College of Dentistry, University of Kentucky, Lexington, KY, USA
| | - J T McDevitt
- Department of Bioengineering and Chemistry, Rice University, Houston, TX, USA
| | - X Ding
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, KY, USA
| | - R J Kryscio
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, KY, USA Department of Statistics, College of Arts & Science, University of Kentucky, Lexington, KY, USA
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Safdar B, Bezek SK, Sinusas AJ, Russell RR, Klein MR, Dziura JD, D'Onofrio G. Elevated CK-MB with a normal troponin does not predict 30-day adverse cardiac events in emergency department chest pain observation unit patients. Crit Pathw Cardiol 2014; 13:14-19. [PMID: 24526146 DOI: 10.1097/hpc.0000000000000001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Prior studies indicate that an elevated creatinine kinase (CK)-MB imparts poor prognosis in patients with acute coronary syndrome despite a normal troponin. Its prognosis in the undifferentiated chest pain observation unit (CPU) population remains undefined. OBJECTIVE To compare rates and predictors of 30-day adverse cardiac events in 2 cohorts (CK ±/MB+ vs. normal [CK ±/MB-]) in low-moderate-risk CPU patients. METHODS Consecutive CPU patients were followed in a retrospective cohort study for primary outcome (acute coronary syndrome, percutaneous transluminal coronary angioplasty, coronary artery bypass graft, abnormal stress test, cardiac hospitalization, or death within 30 days) by using standardized chart reviews and national death registry. Exclusions were: those aged 30 years or younger, positive troponin, ischemic electrocardiogram, hemodynamic instability, heart failure, or dialysis. RESULTS Between January 2006 and April 2009, 2979 patients were eligible, of which 350 excluded and 2629 analyzed. MB+ compared with normal patients were more likely to be: older (mean, 53.4 ± 14 vs. 51.5 ± 12 years; P = 0.04); male (71% vs. 40%; P = 0.01); renal insufficient (5% vs. 2%; P = 0.01); hypertensive (50% vs. 44%; P = 0.04); dyslipidemic (44% vs. 33%; P = 0.01) obese (55% vs. 43%; P = 0.01); and with known coronary artery disease (14% vs. 5%; P < 0.01). Composite adverse events were 213 (8%) and did not significantly differ for either initial MB+ vs. normal (9.1%, 8.0%; odds ratio, 1.1, 0.7-1.9) or serial MB+ vs. normal (7.5%, 7.4%; odds ratio, 1.0, 0.5-1.8). In a multiple logistic regression model, male sex, diabetes, and prior CAD predicted adverse events, whereas CK-MB along with race, hypertension, smoking, dyslipidemia, family history, and obesity did not. CONCLUSIONS Elevated CK-MB does not add value to serial troponin testing in low-moderate-risk CPU patients.
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Affiliation(s)
- Basmah Safdar
- From the Departments of *Emergency Medicine and ‡Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT; †Department of Emergency Medicine, Baylor School of Medicine, Houston, TX; §Brown University School of Medicine, Providence, RI; and ¶Yale Center for Analytical Sciences, New Haven, CT
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Volz KA, Horowitz GL, McGillicuddy DC, Grossman SA, Sanchez LD. Should creatine kinase-MB index be eliminated in patients with indeterminate troponins in the ED? Am J Emerg Med 2012; 30:1574-6. [DOI: 10.1016/j.ajem.2011.08.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Revised: 08/25/2011] [Accepted: 08/25/2011] [Indexed: 11/24/2022] Open
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Ricci F, De Caterina R. Isolated creatine kinase-MB rise with normal cardiac troponins: a strange occurrence with difficult interpretation. J Cardiovasc Med (Hagerstown) 2012; 12:736-40. [PMID: 21857234 DOI: 10.2459/jcm.0b013e32834ae66c] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 37-year-old man is admitted to the hospital for retrosternal chest pain lasting more than 30 min and nonspecific ECG findings. Serial assays of cardiac biomarkers reveal an isolated elevation of creatine kinase-MB and negative troponin levels. A coronary angiography shows normal vessels in the presence of a Thrombolysis in Myocardial Infarction (TIMI) 2 flow. How should this patient be managed and treated? Is it a myocardial infarction? We here provide a review of the relevant literature and suggest that such a strange condition, for which several explanations are possible, involves a worse prognosis than for normal creatine kinase-MB and troponins.
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Affiliation(s)
- Fabrizio Ricci
- Institute of Cardiology, G. d'Annunzio University, Chieti, Italy
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Bossaert L, O'Connor RE, Arntz HR, Brooks SC, Diercks D, Feitosa-Filho G, Nolan JP, Hoek TLV, Walters DL, Wong A, Welsford M, Woolfrey K. Part 9: Acute coronary syndromes: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Resuscitation 2011; 81 Suppl 1:e175-212. [PMID: 20959169 DOI: 10.1016/j.resuscitation.2010.09.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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O'Connor RE, Bossaert L, Arntz HR, Brooks SC, Diercks D, Feitosa-Filho G, Nolan JP, Vanden Hoek TL, Walters DL, Wong A, Welsford M, Woolfrey K. Part 9: Acute coronary syndromes: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 2010; 122:S422-65. [PMID: 20956257 DOI: 10.1161/circulationaha.110.985549] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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McMullin N, Lindsell CJ, Lei L, Mafi J, Jois-Bilowich P, Anantharaman V, Pollack CV, Hollander JE, Gibler WB, Hoekestra JW, Diercks D, Peacock WF. Outcomes associated with small changes in normal-range cardiac markers. Am J Emerg Med 2010; 29:162-7. [PMID: 20825781 DOI: 10.1016/j.ajem.2009.08.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2009] [Revised: 07/22/2009] [Accepted: 08/18/2009] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Troponin concentrations rising above an institutional cutpoint are used to define acute myocardial necrosis, yet it is uncertain what outcomes are associated with fluctuations in troponin that do not exceed this level. We evaluate the association between troponin fluctuations below an institutional upper limit of normal and acute coronary syndrome (ACS). MATERIALS AND METHODS This was a post hoc analysis of the Internet tracking registry of ACS (i*trACS), which describes patients presenting to emergency departments (EDs) with suspected ACS across the spectrum of risk. Patients were included in this registry if they were at least 18 years old and had suspected ACS at the time of their ED visit. Inclusions in this analysis required that patients had at least 1 cardiac marker (creatine kinase-MB [CK-MB], troponin T, or troponin I) drawn twice within 6 hours of presentation, with both measures being below the institution's upper limit of normal. A marker change was defined as either an increase or decrease that exceeded 15% of the institutional upper limit of normal. Acute coronary syndrome was defined as a positive stress test, documented myocardial infarction, coronary revascularization, or death within 30 days of their ED admission. RESULTS Of 17,713 patient visits, 2162 met inclusion and exclusion criteria. There were 1872 patient visits with 2 troponin results and 1312 with 2 CK-MB results. Patient visits with increasing troponin had increased odds of ACS compared with those with stable troponin levels (odds ratio, 3.6; 95% confidence interval, 1.4-9.2). Changing CK-MB and decreasing troponin were not associated with increased odds of ACS. CONCLUSIONS Small increases in troponin concentration below the upper limit of normal are associated with increased odds of ACS.
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Jones ID, Slovis CM. Pitfalls in Evaluating the Low-Risk Chest Pain Patient. Emerg Med Clin North Am 2010; 28:183-201, ix. [DOI: 10.1016/j.emc.2009.10.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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B-Type Natriuretic Peptide (BNP) and ProBNP: Role of Emerging Markers to Guide Therapy and Determine Prognosis in Cardiovascular Disorders. Am J Ther 2008; 15:150-6. [DOI: 10.1097/mjt.0b013e31815af96f] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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