Coronary Artery DiseaseUsefulness of Early Rule-In and Rule-Out Biomarker Protocols to Estimate Ischemia-Induced Myocardial Injury in Early Chest Pain Presenters
Section snippets
Methods
The “early presenter” model was tested in 107 consecutive stable patients in whom a short period of myocardial ischemia was induced during a percutaneous coronary intervention (PCI) of a significant coronary artery stenosis. The time between the onset of pain/ischemia and the first biomarker evaluation was fixed at 90 minutes, and a subsequent biomarker measurement was taken 90 minutes after this first biomarker assessment. Exclusion criteria included a recent myocardial infarction (<1 week), a
Results
A total of 107 patients with a planned PCI were enrolled. Table 1 describes the patient characteristics and procedure-related details. Most patients had a TIMI 3 flow before the percutaneous procedure; there was a TIMI 2 flow in 1 patient and a TIMI 1 flow in 8 patients. The PCI was complicated by 5 dissections of the coronary artery and 1 perforation, which were adequately covered by stents. In 1 patient, there was temporarily no reflow phenomenon during the procedure, and 1 patient showed
Discussion
The present study evaluated the usefulness of early rule-in and rule-out biomarker protocols to estimate ischemia-induced MI in an early presenter model and confirmed our hypothesis that these protocols would underestimate myonecrosis in these patients.
Myonecrosis after PCI was present in 56% to 62% of the patients of our population. The release of cardiac enzyme post-PCI is because of prolonged ischemia after epicardial coronary complications (e.g., side-branch occlusion of coronary
Acknowledgment
The authors wish to thank M.I. Schoorl from the Laboratorium voor KCHI, Medisch Centrum Alkmaar, The Netherlands, for the measurement of copeptin. They are also indebted to Abbott Diagnostics, B.R.A.H.M.S./Thermofisher Scientific, and Roche Diagnostics, for providing the reagents for the measurement of hsTnI, copeptin, and hsTnT, respectively. Finally, we thank Mrs. Domine Torfs for the measurements of biomarkers done in our laboratory.
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Implementing the European Society of Cardiology 0-h/1-h algorithm in patients presenting very early after chest pain
2020, International Journal of CardiologyCitation Excerpt :There are few reports about the kinetics of hs-cTnT in patients with NSTEMI. Vorlat et al. measured hs-cTnT levels in patients with stable coronary artery stenosis after implantation of a stent immediately and 90 min later and showed that the increasing troponin level at 90 min could aid the clinician make a diagnosis of AMI with a PPV of 86% [21], indicating that hs-cTnT concentrations in patients with AMI dramatically increase over time. Therefore, Reichlin et al. emphasized the importance of absolute rather than relative changes in troponin, as well as the use of thresholds below the 99th percentile for the rule-out group [14], and a delta value (<3 ng/L or >52 ng/L) is a number as crucial as the 99th percentile to rule out AMI.
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2019, Transplantation ProceedingsCitation Excerpt :For the remaining 41 patients, measurement of high-sensitivity troponin T was performed using a modular immunoassay instrument (Cobas 6000, Roche Diagnostics, Inc, Vilvoorde, Belgium) with Roche reagents. To achieve a uniform troponin assay, a conversion factor was applied to calculate high-sensitivity troponin T from troponin I, based on previous work [9]. ST2 was determined with the Aspect-PLUS ST2 Rapid Test (Critical Diagnostics Inc, Dublin, Ireland).
Incremental value of copeptin in suspected acute myocardial infarction very early after symptom onset
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