1
|
Leite L, Matos P, Leon-Justel A, Espírito-Santo C, Rodríguez-Padial L, Rodrigues F, Orozco D, Redon J. High sensitivity troponins: A potential biomarkers of cardiovascular risk for primary prevention. Front Cardiovasc Med 2022; 9:1054959. [PMID: 36531726 PMCID: PMC9748104 DOI: 10.3389/fcvm.2022.1054959] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/14/2022] [Indexed: 03/07/2024] Open
Abstract
There have been several approaches to building charts for CV risk, all of which have both strengths and limitations. Identifying early organ damage provides relevant information and should be included in risk charts, although the direct relationship with risk is imprecise, variability between operators at the time to assess, and low availability in some healthcare systems, limits its use. Biomarkers, like troponin (cTns) isoforms cTnI and cTnT, a cardiac specific myocyte injury marker, have the great advantage of being relatively reproducible, more readily accessible, and applicable to different populations. New and improved troponin assays have good analytical performance, can measure very low levels of circulating troponin, and have low intra individual variation, below 10 %. Several studies have analyzed the blood levels in healthy subjects and their predictive value for cardiovascular events in observational, prospective and post-hoc studies. All of them offered relevant information and shown that high sensitivity hs-cTnI has a place as an additional clinical marker to add to current charts, and it also reflects sex- and age-dependent differences. Although few more questions need to be answered before recommend cTnI for assessing CV risk in primary prevention, seems to be a potential strong marker to complement CV risk charts.
Collapse
Affiliation(s)
- Luis Leite
- Cardiology Department, Coimbra University Hospital, University of Coimbra, Coimbra, Portugal
| | - Pedro Matos
- APDP e Hospital CUF Infante Santo, Lisbon, Portugal
| | - Antonio Leon-Justel
- Department of Laboratory Medicine, Virgen Macarena University Hospital, Seville, Spain
| | | | | | | | - Domingo Orozco
- Department of Clinical Medicine, Miguel Hernández University, Elche, Spain
| | - Josep Redon
- INCLIVA Research Institute, University of Valencia, Valencia, Spain
- CIBERObn Institute of Health Carlos III, Madrid, Spain
| |
Collapse
|
2
|
Leistner DM, Dietrich S, Erbay A, Steiner J, Abdelwahed Y, Siegrist PT, Schindler M, Skurk C, Haghikia A, Sinning D, Riedel M, Landmesser U, Stähli BE. Association of left ventricular end‐diastolic pressure with mortality in patients undergoing percutaneous coronary intervention for acute coronary syndromes. Catheter Cardiovasc Interv 2020; 96:E439-E446. [DOI: 10.1002/ccd.28839] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 02/03/2020] [Accepted: 02/25/2020] [Indexed: 11/06/2022]
Affiliation(s)
- David M. Leistner
- Department of Cardiology Charité Berlin – University Medicine, Campus Benjamin Franklin Berlin Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin Berlin Germany
- Berlin Institute of Health (BIH) Berlin Germany
| | - Steven Dietrich
- Department of Cardiology Charité Berlin – University Medicine, Campus Benjamin Franklin Berlin Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin Berlin Germany
| | - Aslihan Erbay
- Department of Cardiology Charité Berlin – University Medicine, Campus Benjamin Franklin Berlin Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin Berlin Germany
| | - Julia Steiner
- Department of Cardiology Charité Berlin – University Medicine, Campus Benjamin Franklin Berlin Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin Berlin Germany
| | - Youssef Abdelwahed
- Department of Cardiology Charité Berlin – University Medicine, Campus Benjamin Franklin Berlin Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin Berlin Germany
| | - Patrick T. Siegrist
- Department of Cardiology University Heart Center, University Hospital Zurich Zurich Switzerland
| | - Matthias Schindler
- Department of Cardiology University Heart Center, University Hospital Zurich Zurich Switzerland
| | - Carsten Skurk
- Department of Cardiology Charité Berlin – University Medicine, Campus Benjamin Franklin Berlin Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin Berlin Germany
| | - Arash Haghikia
- Department of Cardiology Charité Berlin – University Medicine, Campus Benjamin Franklin Berlin Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin Berlin Germany
- Berlin Institute of Health (BIH) Berlin Germany
| | - David Sinning
- Department of Cardiology Charité Berlin – University Medicine, Campus Benjamin Franklin Berlin Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin Berlin Germany
| | - Matthias Riedel
- Department of Cardiology Charité Berlin – University Medicine, Campus Benjamin Franklin Berlin Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin Berlin Germany
| | - Ulf Landmesser
- Department of Cardiology Charité Berlin – University Medicine, Campus Benjamin Franklin Berlin Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin Berlin Germany
- Berlin Institute of Health (BIH) Berlin Germany
| | - Barbara E. Stähli
- Department of Cardiology Charité Berlin – University Medicine, Campus Benjamin Franklin Berlin Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin Berlin Germany
- Department of Cardiology University Heart Center, University Hospital Zurich Zurich Switzerland
| |
Collapse
|
3
|
Leistner DM, Münch C, Steiner J, Lauten A, Landmesser U, Stähli BE. Effect on Outcomes: Infections Complicating Percutaneous Coronary Interventions in Patients ≥80 Years of Age. Am J Cardiol 2019; 123:1806-1811. [PMID: 30910227 DOI: 10.1016/j.amjcard.2019.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 02/24/2019] [Accepted: 03/05/2019] [Indexed: 01/19/2023]
Abstract
Data on the prevalence of infections in patients who underwent percutaneous coronary intervention (PCI) and their impact on outcomes are scarce. In this study, a total of 644 patients ≥80 years of age who underwent PCI were stratified according to the presence/absence of infections requiring antibiotic therapy. The primary end point was major adverse cardiovascular events (MACE) after discharge, a composite of all-cause mortality, nonfatal myocardial infarction, and rehospitalization for heart failure. Median follow-up was 1.2 (interquartile range 0.1 to 3.4) years. Of the 644 patients, 186 (28.9%) had infections during index hospitalization, with 84 (13%) and 59 (9.2%) patients having pneumonia and urinary tract infections, respectively. Patients with infections were older, more often women, and had an increased prevalence of atrial fibrillation and congestive heart failure. Infections prolonged hospital stay (10 [7 to 16] vs 5 [3 to 7] days, p <0.001), but were not related to rates of MACE (20% vs 19%, adjusted hazard ratio [HR] 1.41, 95% confidence intervals 0.84 to 2.38, p = 0.20). Pneumonia was significantly associated with increased rates of MACE (27% vs 18%, adjusted HR 2.19, 95% confidence intervals 1.23 to 3.91, p = 0.008) and rehospitalization for heart failure (17% vs 10%, adjusted HR 2.66 (1.25 to 5.63, p = 0.01), whereas urinary tract infections were not. In conclusion, concomitant infections are frequent in patients ≥80 years of age who underwent PCI, and associated with an increased risk of adverse events when affecting the respiratory system.
Collapse
Affiliation(s)
- David Manuel Leistner
- Department of Cardiology, Charité Berlin - University Medicine, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Berlin, Germany; Berlin Institute of Health (BIH), Berlin, Germany
| | - Charlotte Münch
- Department of Cardiology, Charité Berlin - University Medicine, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - Julia Steiner
- Department of Cardiology, Charité Berlin - University Medicine, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - Alexander Lauten
- Department of Cardiology, Charité Berlin - University Medicine, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - Ulf Landmesser
- Department of Cardiology, Charité Berlin - University Medicine, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Berlin, Germany; Berlin Institute of Health (BIH), Berlin, Germany
| | - Barbara Elisabeth Stähli
- Department of Cardiology, Charité Berlin - University Medicine, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Berlin, Germany; Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland.
| |
Collapse
|
4
|
Liu J, Quan J, Li Y, Wu Y, Yang L. Blood homocysteine levels could predict major adverse cardiac events in patients with acute coronary syndrome: A STROBE-compliant observational study. Medicine (Baltimore) 2018; 97:e12626. [PMID: 30290636 PMCID: PMC6200518 DOI: 10.1097/md.0000000000012626] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The Global Registry of Acute Coronary Events (GRACE) risk score independently predicts major adverse cardiac events (MACEs) in patients with acute coronary syndrome (ACS). This study aims to evaluate whether the level of plasma homocysteine in addition to the GRACE score enhances the predictive value for MACEs in patients with acute coronary syndrome.A total of 361 patients with ACS evaluated at our hospital were included in the study and tested for blood homocysteine levels. We recorded 40 (11.1%) instances of MACE during a median follow-up of 43.3 months (quartile 40.6-44.4 months), including 29 cases (8.0%) of all-cause death and 11 cases (3.1%) of nonfatal myocardial infarction.The GRACE score was significantly associated with homocysteine levels, and multivariate Cox regression analysis showed that both the GRACE risk score and homocysteine content were independent predictors of MACEs (HR 2.63; 95% confidence interval (CI) 1.54 to 4.49; P < .001 and 2.27; 1.06 to 4.86; P = .035, respectively). Moreover, meta-analysis showed that as the homocysteine level increased, the incidence of MACEs also increased (log-rank 8.41; P = .015). GRACE scores adjusted by homocysteine level increased the area under the curve (AUC) from 0.78 to 0.83 (P = 0.006).Blood homocysteine levels are significantly associated with the GRACE risk score, and using both parameters can further improve risk stratification in patients with acute coronary syndrome.
Collapse
Affiliation(s)
- Jianlin Liu
- Department of Vascular Surgery, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an
| | - Jianjun Quan
- Department of Vascular Surgery, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an
- Department of Interventional Cardiology, Hanzhong Central Hospital, Hanzhong
| | | | - Yue Wu
- Department of Cardiology, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Lin Yang
- Department of Vascular Surgery, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an
| |
Collapse
|
5
|
Bai XF, Zhang YP, Zhou J, Wu Y, Li RF, Sun LZ, Ma QQ, Lou BW, Zhai BW, Liu MP, Cheng LL, Tong XN, Yuan ZY. Combination of the CYP2C19 metabolizer and the GRACE risk score better predicts the long-term major adverse cardiac events in acute coronary syndrome undergoing percutaneous coronary intervention. Thromb Res 2018; 170:142-147. [DOI: 10.1016/j.thromres.2018.08.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 07/14/2018] [Accepted: 08/22/2018] [Indexed: 10/28/2022]
|
6
|
Sandø A, Schultz M, Eugen-Olsen J, Rasmussen LS, Køber L, Kjøller E, Jensen BN, Ravn L, Lange T, Iversen K. Introduction of a prognostic biomarker to strengthen risk stratification of acutely admitted patients: rationale and design of the TRIAGE III cluster randomized interventional trial. Scand J Trauma Resusc Emerg Med 2016; 24:100. [PMID: 27491822 PMCID: PMC4974743 DOI: 10.1186/s13049-016-0290-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 07/27/2016] [Indexed: 12/22/2022] Open
Abstract
Background Several biomarkers have shown to carry prognostic value beyond current triage algorithms and may aid in initial risk stratification of patients in the emergency department (ED). It has yet to be established if information provided by biomarkers can be used to prevent serious complications or deaths. Our aim is to determine whether measurement of the blood level of the biomarker soluble urokinase plasminogen activator receptor (suPAR) can enhance early risk stratification leading to reduced mortality, lower rate of complications, and improved patient flow in acutely admitted adult patients at the ED. The main hypothesis is that the availability of suPAR can reduce all-cause mortality, assessed at least 10 months after admission, by drawing attention towards patients with an unrecognized high risk, leading to improved diagnostics and treatment. Methods The study is designed as a cross-over cluster randomized interventional trial. SuPAR is measured within 2 h after admission and immediately reported to the treating physicians in the ED. All ED physicians are educated in the prognostic capabilities of suPAR prior to the inclusion period. The inclusion period began January 11th 2016 and ends June 6th 2016. The study aims to include 10.000 patients in both the interventional and control arm. The results will be presented in 2017. Discussion The present article aims to describe the design and rationale of the TRIAGE III study that will investigate whether the availability of prognostic information can improve outcome in acutely admitted patients. This might have an impact on health care organization and decision-making. Trial registration The trial is registered at clinicaltrials.gov (ID NCT02643459, November 13, 2015) and at the Danish Data Protection agency (ID HGH-2015-042 I-Suite no. 04087).
Collapse
Affiliation(s)
- Andreas Sandø
- Department of Cardiology, Herlev Hospital, University of Copenhagen, Herlev Ringvej 75, 2730, Herlev, Denmark.
| | - Martin Schultz
- Department of Cardiology, Herlev Hospital, University of Copenhagen, Herlev Ringvej 75, 2730, Herlev, Denmark.,Clinical Research Centre, Hvidovre Hospital, University of Copenhagen, Kettegård Alle 30, 2650, Hvidovre, Denmark
| | - Jesper Eugen-Olsen
- Clinical Research Centre, Hvidovre Hospital, University of Copenhagen, Kettegård Alle 30, 2650, Hvidovre, Denmark
| | - Lars Simon Rasmussen
- Department of Anaesthesia, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Erik Kjøller
- Department of Cardiology, Herlev Hospital, University of Copenhagen, Herlev Ringvej 75, 2730, Herlev, Denmark
| | - Birgitte Nybo Jensen
- Department of Emergency Medicine, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400, Copenhagen, Denmark
| | - Lisbet Ravn
- Department of Emergency Medicine, Herlev Hospital, University of Copenhagen, Herlev Ringvej 75, 2730, Herlev, Denmark
| | - Theis Lange
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark
| | - Kasper Iversen
- Department of Cardiology, Herlev Hospital, University of Copenhagen, Herlev Ringvej 75, 2730, Herlev, Denmark
| |
Collapse
|
7
|
Risøe C. Suspected Acute Coronary Syndromes in Women. Cardiology 2015; 133:1-2. [PMID: 26355436 DOI: 10.1159/000438667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 06/29/2015] [Indexed: 11/19/2022]
Affiliation(s)
- Cecilie Risøe
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| |
Collapse
|
8
|
Liu XJ, Wan ZF, Zhao N, Zhang YP, Mi L, Wang XH, Zhou D, Wu Y, Yuan ZY. Adjustment of the GRACE score by HemoglobinA1c enables a more accurate prediction of long-term major adverse cardiac events in acute coronary syndrome without diabetes undergoing percutaneous coronary intervention. Cardiovasc Diabetol 2015; 14:110. [PMID: 26285575 PMCID: PMC4541750 DOI: 10.1186/s12933-015-0274-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 08/08/2015] [Indexed: 12/02/2022] Open
Abstract
Background The Global Registry of Acute Coronary Events (GRACE) risk score is widely recommended for risk assessment in patients with acute coronary syndrome (ACS). Chronic hyperglycemia [hemoglobinA1c (HbA1c)] can independently predict major adverse cardiac events (MACEs) in patients with ACS. We investigated whether the prediction of MACEs with the GRACE score could be improved with the addition of HbA1c content in ACS patients without diabetes mellitus (DM) undergoing percutaneous coronary intervention (PCI). Methods We enrolled 549 ACS patients without DM who underwent PCI. The GRACE score and HbA1c content were determined on admission. Correlation was analyzed by Spearman’s rank correlation. Cumulative MACE curve was calculated using the Kaplan–Meier method. Multivariate Cox regression was used to identify predictors of MACEs. Additionally, the predictive value of HbA1c content alone and combined with GRACE score was estimated by the area under the receiver-operating characteristic curve (AUC), continuous net reclassification improvement (NRI) and integrated discrimination improvement (IDI). Results During a median of 42.3 months (interquartile range 39.3–44.2 months), 16 (2.9 %) were lost to follow-up, and patients experienced 69 (12.9 %) MACEs: 51 (9.6 %) all-cause deaths and 18 (3.4 %) nonfatal myocardial infarction cases. The GRACE score was positively associated with HbA1c content. Multivariate Cox analysis showed that both GRACE score and HbA1c content were independent predictors of MACEs (hazard ratio 1.030; 95 % CI 1.020–1.040; p < 0.001; 3.530; 95 % CI 1.927–6.466; p < 0.001, respectively). Furthermore, Kaplan–Meier analysis demonstrated increased risk of MACEs with increasing HbA1c content (log-rank 33.906, p < 0.001). Adjustment of the GRACE risk estimate by HbA1c improved the predictive value of the GRACE score [increase in AUC from 0.75 for the GRACE score to 0.80 for the GRACE score plus HbA1c, p = 0.012; IDI = 0.055, p < 0.001; NRI (>0) = 0.70, p < 0.001]. Conclusions HbA1c content is positively associated with GRACE risk score and their combination further improved the risk stratification for ACS patients without DM undergoing PCI. Electronic supplementary material The online version of this article (doi:10.1186/s12933-015-0274-4) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Xiao-Jun Liu
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China.
| | - Zhao-Fei Wan
- First Department of Cardiology, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China.
| | - Na Zhao
- First Department of Cardiology, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China.
| | - Ya-Ping Zhang
- Department of Ophthalmology Medicine, Xi'an IV People's Hospital, Xi'an, Shaanxi, China.
| | - Lan Mi
- Peking University Cancer Hospital and Institute, Beijing, China.
| | - Xin-Hong Wang
- Department of Cardiovascular Medicine, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.
| | - Dong Zhou
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China.
| | - Yan Wu
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China.
| | - Zu-Yi Yuan
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China. .,Key Laboratory of Environment and Genes Related to Diseases, Xi'an Jiaotong University, Ministry of Education, Xi'an, Shaanxi, China.
| |
Collapse
|
9
|
Sara JDS, Holmes DR, Jaffe AS. Fundamental concepts of effective troponin use: important principles for internists. Am J Med 2015; 128:111-9. [PMID: 25232717 DOI: 10.1016/j.amjmed.2014.08.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 08/12/2014] [Accepted: 08/12/2014] [Indexed: 11/26/2022]
Abstract
Troponin testing is an essential component of our diagnostic approach to patients in acute medical care settings. With the advent of high-sensitivity troponin assays, its importance will extend to patients in chronic disease settings. Although elevated troponin levels provide diagnostic information, inform treatment decisions, and influence patient prognosis, proper interpretation of the values is essential. This requires an understanding of the operating characteristics of troponin testing; the likelihood ratios associated with a positive/negative test result and the pre- and post-test probabilities related to individual clinical settings. These principles will become more important as high-sensitivity assays become introduced over the coming years in the United States. This article reviews the important principles of troponin testing focusing in particular on acute settings and is aimed at internal medicine and hospital specialists.
Collapse
Affiliation(s)
- Jaskanwal D S Sara
- Division of Cardiovascular Diseases, Mayo College of Medicine, Rochester, Minn.
| | - David R Holmes
- Division of Cardiovascular Diseases, Mayo College of Medicine, Rochester, Minn
| | - Allan S Jaffe
- CCLS Division of Laboratory Medicine and Pathology, Mayo College of Medicine, Rochester, Minn
| |
Collapse
|