Markers of plaque instability in the early diagnosis and risk stratification of acute myocardial infarction
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Markers of plaque instability in the early diagnosis and risk stratification of acute myocardial infarction. / Schaub, Nora; Reichlin, Tobias; Meune, Christophe; Twerenbold, Raphael; Haaf, Philip; Hochholzer, Willibald; Niederhauser, Nadine; Bosshard, Piet; Stelzig, Claudia; Freese, Michael; Reiter, Miriam; Gea, Joachim; Buser, Andreas; Mebazaa, Alexandre; Osswald, Stefan; Mueller, Christian.
In: CLIN CHEM, Vol. 58, No. 1, 01.2012, p. 246-56.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Markers of plaque instability in the early diagnosis and risk stratification of acute myocardial infarction
AU - Schaub, Nora
AU - Reichlin, Tobias
AU - Meune, Christophe
AU - Twerenbold, Raphael
AU - Haaf, Philip
AU - Hochholzer, Willibald
AU - Niederhauser, Nadine
AU - Bosshard, Piet
AU - Stelzig, Claudia
AU - Freese, Michael
AU - Reiter, Miriam
AU - Gea, Joachim
AU - Buser, Andreas
AU - Mebazaa, Alexandre
AU - Osswald, Stefan
AU - Mueller, Christian
PY - 2012/1
Y1 - 2012/1
N2 - BACKGROUND: Plaque erosion and plaque rupture occur early in the pathophysiology of acute myocardial infarction (AMI). We hypothesized that markers of plaque instability might be useful in the early diagnosis and risk stratification of AMI.METHODS: In this multicenter study, we examined 4 markers of plaque instability, myeloperoxidase (MPO), myeloid-related protein 8/14 (MRP-8/14), pregnancy-associated plasma protein-A (PAPP-A), and C-reactive protein (CRP) in 398 consecutive patients presenting to the emergency department with acute chest pain and compared them to normal and high-sensitivity cardiac troponin T (cTnT and hs-cTnT). The final diagnosis was adjudicated by 2 independent cardiologists. Primary prognostic end point was death during a median follow-up of 27 months.RESULTS: The adjudicated final diagnosis was AMI in 76 patients (19%). At emergency department presentation, concentrations of all 4 biomarkers of plaque instability were significantly higher in patients with AMI than in patients with other diagnoses. However, their diagnostic accuracy as quantified by the area under the ROC curve (AUC) was low (MPO 0.63, MRP-8/14 0.65, PAPP-A 0.62, CRP 0.59) and inferior to both normal and high-sensitivity cardiac troponin T (cTnT 0.88, hs-cTnT 0.96; P<0.001 for all comparisons). Thirty-nine patients (10%) died during follow-up. Concentrations of MPO, MRP-8/14, and CRP were higher in nonsurvivors than in survivors and predicted all-cause mortality with moderate accuracy.CONCLUSIONS: Biomarkers of plaque instability do not seem helpful in the early diagnosis of AMI but may provide some incremental value in the risk stratification of patients with acute chest pain.
AB - BACKGROUND: Plaque erosion and plaque rupture occur early in the pathophysiology of acute myocardial infarction (AMI). We hypothesized that markers of plaque instability might be useful in the early diagnosis and risk stratification of AMI.METHODS: In this multicenter study, we examined 4 markers of plaque instability, myeloperoxidase (MPO), myeloid-related protein 8/14 (MRP-8/14), pregnancy-associated plasma protein-A (PAPP-A), and C-reactive protein (CRP) in 398 consecutive patients presenting to the emergency department with acute chest pain and compared them to normal and high-sensitivity cardiac troponin T (cTnT and hs-cTnT). The final diagnosis was adjudicated by 2 independent cardiologists. Primary prognostic end point was death during a median follow-up of 27 months.RESULTS: The adjudicated final diagnosis was AMI in 76 patients (19%). At emergency department presentation, concentrations of all 4 biomarkers of plaque instability were significantly higher in patients with AMI than in patients with other diagnoses. However, their diagnostic accuracy as quantified by the area under the ROC curve (AUC) was low (MPO 0.63, MRP-8/14 0.65, PAPP-A 0.62, CRP 0.59) and inferior to both normal and high-sensitivity cardiac troponin T (cTnT 0.88, hs-cTnT 0.96; P<0.001 for all comparisons). Thirty-nine patients (10%) died during follow-up. Concentrations of MPO, MRP-8/14, and CRP were higher in nonsurvivors than in survivors and predicted all-cause mortality with moderate accuracy.CONCLUSIONS: Biomarkers of plaque instability do not seem helpful in the early diagnosis of AMI but may provide some incremental value in the risk stratification of patients with acute chest pain.
KW - Acute Coronary Syndrome/diagnosis
KW - Aged
KW - Aged, 80 and over
KW - Area Under Curve
KW - Biomarkers/blood
KW - C-Reactive Protein/analysis
KW - Calgranulin A/blood
KW - Calgranulin B/blood
KW - Chest Pain/blood
KW - Early Diagnosis
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Myocardial Infarction/diagnosis
KW - Peroxidase/blood
KW - Plaque, Atherosclerotic/complications
KW - Pregnancy-Associated Plasma Protein-A/analysis
KW - Prognosis
KW - ROC Curve
KW - Risk Assessment
KW - Troponin T/blood
U2 - 10.1373/clinchem.2011.172940
DO - 10.1373/clinchem.2011.172940
M3 - SCORING: Journal article
C2 - 22057876
VL - 58
SP - 246
EP - 256
JO - CLIN CHEM
JF - CLIN CHEM
SN - 0009-9147
IS - 1
ER -