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

Sanchis, J.; Bosch, X.; Bodí, V.; Bellera, N.; N!ñEz, J.; Benito, B.; Ordóñez, J.; Consuegra, L.; Heras, M.; Lacer, À.
March 2008
Heart;Mar2008, Vol. 94 Issue 3, p311
Academic Journal
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.


Related Articles

  • ACC/AHA Pocket Guidelines on Acute MI and Chronic Stable Angina. Preboth, Monica // American Family Physician;10/1/2000, Vol. 62 Issue 7, p1707 

    Reports on the collaboration of the American College of Cardiology (ACC) and the American Heart Association (AHA) on a series of guidelines to provide physicians with a quick reference to the diagnostic and therapeutic recommendations contained in the ACC/AHA practice guidelines for acute...

  • Your ED's next acute MI patient might not be what you're expecting.  // ED Nursing;Apr2010, Vol. 13 Issue 6, p61 

    Atypical symptoms of acute myocardial infarction (AMI) are more common than expected, according to a just-published study. To avoid missing an AMI in your ED: • don't exclude AMI even if pain duration is five minutes or less; • obtain an immediate EKG if there is no apparent...

  • Novel imaging techniques reveal the aetiology of a pseudoinfarction ECG pattern. Leftheriotis, D.; Ikonomidis, I.; Iliodromitis, E. K.; Kremastinos, D. Th. // Heart;Sep2006, Vol. 92 Issue 9, p1338 

    The article presents a case of a 64-year-old patient complaining of chest discomfort with an electrocardiogram compatible to myocardial infarction. Transthoracic echocardiography showed a large mass in the right ventricle attached to the lateral. The case presents a new diagnostic application of...

  • The Language of the Heart. Agatston, Arthur // Prevention;May2008, Vol. 60 Issue 5, p39 

    The author reports on the symptoms patients feel when having a heart attack. According to the article, symptoms which people should be concerned about include persistent chest pain, varied shortness of breath and unusual upper-body pain. Steps which people can take to learn if the pain they are...

  • Modes of presentation of acute myocardial infarction. Chowta, K. N.; Prijith, P. D.; Chowta, M. N. // Indian Journal of Critical Care Medicine;Jul-Sep2005, Vol. 9 Issue 3, p151 

    Aim: To study the various modes of presentation of acute myocardial infarction (AMI). Methods: A total number of 60 patients of AMI admitted in various teaching hospitals of Kasturba Medical College, Mangalore, were studied. The following factors were evaluated: onset of symptoms, mode of...

  • Simultaneous Multivessel Coronary Spasm Causing Acute Myocardial Infarction: A Case Report. Saito, Hidenori; Itoh, Tomonori; Itoh, Masahiro; Kanaya, Yoshinori; Suzuki, Tomomi; Hiramori, Katsuhiko // Angiology;Feb/Mar2007, Vol. 58 Issue 1, p112 

    Spontaneous simultaneous multivessel coronary artery spasm in patients with acute myocardial infarction (AMI) is uncommon. A 79-year-old Japanese man was transferred to this hospital because of severe prolonged chest pain and faintness. Left coronary angiography revealed total occlusion of the...

  • Recognising "painless" heart attacks. Wong, C-K; White, H. D. // Heart;Jan2002, Vol. 87 Issue 1, p3 

    Heart attacks without chest pain all too often go unrecognised and untreated.

  • Left Stellate Ganglion Block for Continuous Ventricular Arrhythmias. Loyalka, Pranav; Hariharan, Ramesh; Gholkar, Gunjan; Gregoric, Igor D.; Tamerisa, Ravi; Nathan, Sriram; Kar, Biswajit // Texas Heart Institute Journal;2011, Vol. 38 Issue 4, p409 

    A 58-year-old man presented with chest pain and tightness and was diagnosed with a Q-wave anterior myocardial infarction. He then developed pulseless ventricular arrhythmias, which were treated with repeated direct-current shocks and intravenous amiodarone. He underwent emergency cardiac...

  • The Missed MI: Understanding the Limits of Biomarkers and CT Angiography. Hals, Gary; LoVecchio, Frank // Emergency Medicine Reports;6/22/2009, Vol. 30 Issue 14, p173 

    • Serial cardiac biomarkers over 9 to 12 hours remain the gold standard, but shorter sampling intervals and single measures are appropriate in selected patients. • Chest pain units remain the most realistic approach to reducing the rate of missed MIs. • ACS risk score...


Read the Article


Sign out of this library

Other Topics