title: Clinical criteria replenish high-sensitive troponin and inflammatory markers in the stratification of patients with suspected acute coronary syndrome.
abstract: OBJECTIVE
  In patients with suspected acute coronary syndrome (ACS), rapid triage is essential. The aim of this study was to establish a tool for risk prediction of 30-day cardiac events (CE) on admission. 30-day cardiac events (CE) were defined as early coronary revascularization, subsequent myocardial infarction, or cardiovascular death within 30 days.
  
  
  RESULTS
  This single-centre, prospective cohort study included 377 consecutive patients presenting to the emergency department with suspected ACS and for whom troponin T measurements were requested on clinical grounds. Fifteen biomarkers were analyzed in the admission sample, and clinical parameters were assessed by the TIMI risk score for unstable angina/Non-ST myocardial infarction and the GRACE risk score. Sixty-nine (18%) patients presented with and 308 (82%) without ST-elevations, respectively. Coronary angiography was performed in 165 (44%) patients with subsequent percutaneous coronary intervention--accounting for the majority of CE--in 123 (33%) patients, respectively. Eleven out of 15 biomarkers were elevated in patients with CE compared to those without. High-sensitive troponin T (hs-cTnT) was the best univariate biomarker to predict CE in Non-ST-elevation patients (AUC 0.80), but did not yield incremental information above clinical TIMI risk score (AUC 0.80 vs 0.82, p = 0.69). Equivalence testing of AUCs of risk models and non-inferiority testing demonstrated that the clinical TIMI risk score alone was non-inferior to its combination with hs-cTnT in predicting CE.
  
  
  CONCLUSIONS
  In patients presenting without ST-elevations, identification of those prone to CE is best based on clinical assessment based on TIMI risk score criteria and hs-cTnT.
authors.affiliation: Department of Cardiology, Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Barbara Elisabeth
authors.initials: BE
authors.lastname: Stähli
authors.affiliation: Department of Cardiology, Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland; Division of Internal Medicine, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Keiko
authors.initials: K
authors.lastname: Yonekawa
authors.affiliation: Department of Cardiology, Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Lukas Andreas
authors.initials: LA
authors.lastname: Altwegg
authors.affiliation: Department of Cardiology, Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Christophe
authors.initials: C
authors.lastname: Wyss
authors.affiliation: Institute of Clinical Chemistry, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Danielle
authors.initials: D
authors.lastname: Hof
authors.affiliation: Department of Internal Medicine, Hospital Männedorf, Männedorf, Switzerland.
authors.forename: Philipp
authors.initials: P
authors.lastname: Fischbacher
authors.affiliation: Department of Cardiology, Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Andreas
authors.initials: A
authors.lastname: Brauchlin
authors.affiliation: Department of Internal Medicine, Hospital Männedorf, Männedorf, Switzerland.
authors.forename: Georg
authors.initials: G
authors.lastname: Schulthess
authors.affiliation: Division of Internal Medicine, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Pierre-Alexandre
authors.initials: PA
authors.lastname: Krayenbühl
authors.affiliation: Institute of Clinical Chemistry, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Arnold
authors.initials: A
authors.lastname: von Eckardstein
authors.affiliation: Institute of Clinical Chemistry and Biochemistry, Childrens Hospital Zurich, Zurich, Switzerland.
authors.forename: Martin
authors.initials: M
authors.lastname: Hersberger
authors.affiliation: Center for Experimental Rheumatology, Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Michel
authors.initials: M
authors.lastname: Neidhart
authors.affiliation: Center for Experimental Rheumatology, Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Steffen
authors.initials: S
authors.lastname: Gay
authors.affiliation: FB Mathematics and Computer Science, University of Bremen, Bremen, Germany.
authors.forename: Igor
authors.initials: I
authors.lastname: Novopashenny
authors.affiliation: FB Mathematics and Computer Science, University of Bremen, Bremen, Germany.
authors.forename: Regine
authors.initials: R
authors.lastname: Wolters
authors.affiliation: Department of Cardiology, Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Michelle
authors.initials: M
authors.lastname: Frank
authors.affiliation: FB Mathematics and Computer Science, University of Bremen, Bremen, Germany.
authors.forename: Manfred Bernd
authors.initials: MB
authors.lastname: Wischnewsky
authors.affiliation: Department of Cardiology, Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Thomas Felix
authors.initials: TF
authors.lastname: Lüscher
authors.affiliation: Department of Cardiology, Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Willibald
authors.initials: W
authors.lastname: Maier
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis* / Q000378:metabolism*; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000378:metabolism; D062645:Percutaneous Coronary Intervention; D011446:Prospective Studies; D014336:Troponin / Q000378:metabolism*; D020107:Troponin T / Q000378:metabolism
chemical_list: D014336:Troponin; D020107:Troponin T