TITLE

Combination of clinical risk profile, early exercise testing and circulating biomarkers for evaluation of patients with acute chest pain without ST-segment deviation or troponin elevation

AUTHOR(S)
Sanchis, J.; Bosch, X.; Bodí, V.; Bellera, N.; N!ñEz, J.; Benito, B.; Ordóñez, J.; Consuegra, L.; Heras, M.; Lacer, À.
PUB. DATE
March 2008
SOURCE
Heart;Mar2008, Vol. 94 Issue 3, p311
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Objective: To investigate the combination of clinical data, exercise testing and biomarkers for the evaluation of patients with chest pain without ST-segment deviation or troponin elevation. Design: Prospective cohort design. Settting: Two teaching hospitals in Spain. Patients: 422 patients presenting to the emergency department were studied. Leukocyte count, C-reactive protein (CAP), pregnancy-associated plasma protein A (PAPP-A( and N-terminal pro-brain natriuretic peptide (NT- proBNP( were determined. A validated clinical risk score (number of points according to pain characteristics and risk factors) was used for clinical evaluation and early exercise testing was performed. Main outcome measures: Adverse events (death, myocardial infarction or revascularisation( during a median 60 weeks follow-up. Results: By receiver operating characteristic curve analysis, the association between death or myocardial infarction and adverse events was not significant with leukocyte count (p = 0.3, p = 0.3) or CAP (p = 0.5, p = 0.8), was borderline significant with PAPP-A (p = 0.07, p = 0.04) and strongly significant with NT-pro- BNP (p = 0.0001, p = 0.0001L By Cox regression including clinical risk score, exercise testing result and biomarkers, exercise testing was the independent predictor of revascularisation (p = 0.0001), whereas risk score (p = 0.03) and NT-proBNP (p = 0.0004) predicted death or myocardial infarction. The inclusion of NT-proBNP improved the accuracy of the model for death or myocardial infarction (C-statistic 0.84 versus 0.76, p = 0.01). The combination of clinical score and NT- proBNP afforded the stratification in high (17.2%, p = 0.0001), intermediate (5.3%) and low (1.1%) risk categories of death or myocardial infarction. Conclusions: NT-proBNP provides incremental prognostic information above that given by clinical history and exercise testing in patients with chest pain without ST-segment deviation and negative troponin.
ACCESSION #
31301588

 

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