Utility of C-terminal proendothelin in the early diagnosis and risk stratification of patients with suspected acute myocardial infarction
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Utility of C-terminal proendothelin in the early diagnosis and risk stratification of patients with suspected acute myocardial infarction. / Haaf, Philip; Zellweger, Christa; Reichlin, Tobias; Zbinden, Anina; Wildi, Karin; Mosimann, Tamina; Twerenbold, Raphael; Reiter, Miriam; Balmelli, Cathrin; Freidank, Heike; Gimenez, Maria Rubini; Peter, Federico; Freese, Michael; Stelzig, Claudia; Hartmann, Beate; Dinter, Christiane; Osswald, Stefan; Mueller, Christian.
In: CAN J CARDIOL, Vol. 30, No. 2, 02.2014, p. 195-203.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Utility of C-terminal proendothelin in the early diagnosis and risk stratification of patients with suspected acute myocardial infarction
AU - Haaf, Philip
AU - Zellweger, Christa
AU - Reichlin, Tobias
AU - Zbinden, Anina
AU - Wildi, Karin
AU - Mosimann, Tamina
AU - Twerenbold, Raphael
AU - Reiter, Miriam
AU - Balmelli, Cathrin
AU - Freidank, Heike
AU - Gimenez, Maria Rubini
AU - Peter, Federico
AU - Freese, Michael
AU - Stelzig, Claudia
AU - Hartmann, Beate
AU - Dinter, Christiane
AU - Osswald, Stefan
AU - Mueller, Christian
N1 - Copyright © 2014 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
PY - 2014/2
Y1 - 2014/2
N2 - BACKGROUND: Endothelial dysfunction plays a major role in cardiovascular diseases, including acute myocardial infarction (AMI). However, its quantification has not been available as a clinical tool.METHODS: In a prospective international multicentre study, we analyzed the diagnostic and prognostic utility of endothelial dysfunction as quantified by C-terminal proendothelin-1 (CT-proET-1) in 658 consecutive patients presenting with suspected AMI. The final diagnosis was adjudicated by 2 independent cardiologists. Patients were followed long-term for mortality.RESULTS: The adjudicated final diagnosis was AMI in 145 patients (22%). The diagnostic performance of CT-proET-1 for AMI was moderate; its area under the receiver operating characteristic (ROC) curve amounted to 0.66 (95% confidence interval [CI], 0.61-0.72; P < 0.001). There was no significant increase in the AUC when CT-proET-1 was added to either cardiac troponin T (cTnT) or high-sensitivity cTnT (hs-cTnT). Seventy four percent of patients who died during the first 24 months (n = 50) were in the fourth quartile of the CT-proET-1 presentation value (>82 pmol/L). The prognostic accuracy of CT-proET-1 regarding mortality was tantamount to that of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and outperformed cTnT and hs-cTnT both in patients with AMI and in patients without acute coronary syndrome. CT-proET-1 at presentation yielded high prognostic accuracy that was similar to that of the Thrombolysis in Myocardial Infarction (TIMI) and Global Registry of Acute Coronary Events (GRACE) risk scores. The TIMI risk score could be significantly improved by adding CT-proET-1 (integrated discriminatory improvement [IDI] of 0.074 P = 0.004).CONCLUSIONS: Use of CT-proET-1 improves risk stratification of unselected patients with suspected AMI. CT-proET-1 did not provide additional diagnostic value.
AB - BACKGROUND: Endothelial dysfunction plays a major role in cardiovascular diseases, including acute myocardial infarction (AMI). However, its quantification has not been available as a clinical tool.METHODS: In a prospective international multicentre study, we analyzed the diagnostic and prognostic utility of endothelial dysfunction as quantified by C-terminal proendothelin-1 (CT-proET-1) in 658 consecutive patients presenting with suspected AMI. The final diagnosis was adjudicated by 2 independent cardiologists. Patients were followed long-term for mortality.RESULTS: The adjudicated final diagnosis was AMI in 145 patients (22%). The diagnostic performance of CT-proET-1 for AMI was moderate; its area under the receiver operating characteristic (ROC) curve amounted to 0.66 (95% confidence interval [CI], 0.61-0.72; P < 0.001). There was no significant increase in the AUC when CT-proET-1 was added to either cardiac troponin T (cTnT) or high-sensitivity cTnT (hs-cTnT). Seventy four percent of patients who died during the first 24 months (n = 50) were in the fourth quartile of the CT-proET-1 presentation value (>82 pmol/L). The prognostic accuracy of CT-proET-1 regarding mortality was tantamount to that of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and outperformed cTnT and hs-cTnT both in patients with AMI and in patients without acute coronary syndrome. CT-proET-1 at presentation yielded high prognostic accuracy that was similar to that of the Thrombolysis in Myocardial Infarction (TIMI) and Global Registry of Acute Coronary Events (GRACE) risk scores. The TIMI risk score could be significantly improved by adding CT-proET-1 (integrated discriminatory improvement [IDI] of 0.074 P = 0.004).CONCLUSIONS: Use of CT-proET-1 improves risk stratification of unselected patients with suspected AMI. CT-proET-1 did not provide additional diagnostic value.
KW - Aged
KW - Early Diagnosis
KW - Electrocardiography
KW - Endothelin-1/blood
KW - Female
KW - Follow-Up Studies
KW - Humans
KW - Incidence
KW - Male
KW - Middle Aged
KW - Myocardial Infarction/blood
KW - Peptide Fragments/blood
KW - Prognosis
KW - Prospective Studies
KW - ROC Curve
KW - Risk Assessment/methods
KW - Risk Factors
KW - Survival Rate/trends
KW - Switzerland/epidemiology
U2 - 10.1016/j.cjca.2013.11.020
DO - 10.1016/j.cjca.2013.11.020
M3 - SCORING: Journal article
C2 - 24461921
VL - 30
SP - 195
EP - 203
JO - CAN J CARDIOL
JF - CAN J CARDIOL
SN - 0828-282X
IS - 2
ER -
