title: Investigation of a multimarker approach to the initial assessment of patients with acute chest pain.
abstract: Early identification of acute coronary syndrome (ACS) is important to guide therapy at a time when it is most likely to be of value. In addition, predicting future risk helps identify those most likely to benefit from ongoing therapy. Cardiac troponin T (cTnT) is useful for both purposes although cannot reliably rule out ACS until 12 hours after pain onset and does not fully define future risk. In this review article we summarize our previously published research, which assessed the value of myocyte injury, vascular inflammation, hemostatic, and neurohormonal markers in the early diagnosis of ACS and risk stratification of patients with ACS. In addition to cTnT, we measured heart fatty acid binding protein (H-FABP), glycogen phosphorylase-BB, high-sensitivity C-reactive protein, myeloperoxidase, matrix metalloproteinase 9, pregnancy-associated plasma protein-A, D-dimer, soluble CD40 ligand, and N-terminal pro-brain natriuretic peptide (NT-proBNP). Of the 664 patients enrolled, 415 met inclusion criteria for the early diagnosis of acute myocardial infarction (MI) analysis; 555 were included in the risk stratification analysis and were followed for 1 year from admission. In patients presenting <4 hours from pain onset, initial H-FABP had higher sensitivity for acute MI than cTnT (73% vs. 55%; P=0.043) but was of no benefit beyond 4 hours when compared to cTnT. On multivariate analysis, H-FABP, NT-proBNP, and peak cTnT were independent predictors of 1-year death/MI. Our research demonstrated that, in patients presenting within 4 hours from pain onset, H-FABP may improve detection of ACS. Measuring H-FABP and proBNP may help improve long-term risk stratification.
authors.affiliation: Royal Victoria Hospital, Belfast, Northern Ireland, UK.
authors.forename: C J
authors.initials: CJ
authors.lastname: McCann
authors.forename: B M
authors.initials: BM
authors.lastname: Glover
authors.forename: I B A
authors.initials: IB
authors.lastname: Menown
authors.forename: M J
authors.initials: MJ
authors.lastname: Moore
authors.forename: J
authors.initials: J
authors.lastname: McEneny
authors.forename: C G
authors.initials: CG
authors.lastname: Owens
authors.forename: B
authors.initials: B
authors.lastname: Smith
authors.forename: P C
authors.initials: PC
authors.lastname: Sharpe
authors.forename: I S
authors.initials: IS
authors.lastname: Young
authors.forename: J A
authors.initials: JA
authors.lastname: Adgey
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000175:diagnosis* / Q000378:metabolism* / Q000401:mortality; D015415:Biomarkers / Q000378:metabolism*; D002097:C-Reactive Protein / Q000378:metabolism; D023201:CD40 Ligand / Q000097:blood; D002637:Chest Pain / Q000209:etiology; D042241:Early Diagnosis; D000074026:Fatty Acid Binding Protein 3; D050556:Fatty Acid-Binding Proteins / Q000097:blood; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D025002:Glycogen Phosphorylase, Brain Form / Q000097:blood; D006801:Humans; D020780:Matrix Metalloproteinase 9 / Q000097:blood; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis* / Q000378:metabolism* / Q000401:mortality; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D009195:Peroxidase / Q000097:blood; D011237:Predictive Value of Tests; D011266:Pregnancy-Associated Plasma Protein-A / Q000378:metabolism; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods; D020107:Troponin T / Q000097:blood
chemical_list: D015415:Biomarkers; C493408:FABP3 protein, human; D000074026:Fatty Acid Binding Protein 3; D050556:Fatty Acid-Binding Proteins; D005338:Fibrin Fibrinogen Degradation Products; D010446:Peptide Fragments; D020107:Troponin T; C036309:fibrin fragment D; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D023201:CD40 Ligand; D002097:C-Reactive Protein; D009195:Peroxidase; D025002:Glycogen Phosphorylase, Brain Form; D011266:Pregnancy-Associated Plasma Protein-A; D020780:Matrix Metalloproteinase 9