title: Different characteristics of cardiac biomarkers to decide and predict the culprit lesions in patients with suspicious acute coronary syndrome.
abstract: This multicenter prospective study was conducted to assess high-sensitivity troponin T (hs-TnT) and other biomarkers to decide and predict culprit lesions indicated for emergency percutaneous coronary intervention (PCI) in patients with suspicious acute coronary syndrome (ACS). We have reported Hs-TnT is the most sensitive biomarker for earlier diagnosis and decision making in patients with suspected ACS. In this study, we had conducted subanalysis investigating the usefulness for prediction of ACS culprit lesion. The patients with suspicious ACS and initially negative whole-blood rapid troponin T test, who underwent coronary angiogram (CAG), were enrolled (n = 74). Hs-TnT, quantitative assay for conventional troponin T (c-TnT), creatine kinase MB isozyme (CK-MB), and heart-type fatty acid-binding protein (H-FABP) were simultaneously measured. ACS culprit lesion was described as total occlusion, subtotal occlusion, and/or angiographical unstable lesion such as thrombosis, ulceration or irregularity. The CAG revealed that 49 cases had ACS lesions to be indicated for emergency PCI. The areas under the ROC curves and ROC-optimized cut-off of hs-TnT, c-TnT, CK-MB, and H-FABP were 0.75, 0.67, 0.68, and 0.75, respectively, and 18, 11, 2.0, and 4.6 ng/ml, respectively. In patients with total occlusion and 90-99 % of diameter stenosis (TIMI 2 or 3), hs-TnT could predict emergency PCI with significantly higher sensitivity compared with H-FABP (hs-TnT >14 ng/ml; 71 %, and H-FABP >6.2 ng/dl; 51 %, p = 0.021) and other biomarkers. Meanwhile, H-FABP displayed significant correlations with number of diseased vessels and presence of thrombotic lesion. The present study first revealed different characteristics of correlation between the angiographic culprit lesions and each cardiac biomarker. For prediction of ACS lesions requiring emergency PCI, hs-TnT had the highest sensitivity with satisfied analytical precision.
authors.affiliation: Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, 1715, Kamagari, Inzai, Chiba, 270-1694, Japan. s7022@nms.ac.jp.
authors.forename: Mitsunobu
authors.initials: M
authors.lastname: Kitamura
authors.affiliation: Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, 1715, Kamagari, Inzai, Chiba, 270-1694, Japan.
authors.forename: Noritake
authors.initials: N
authors.lastname: Hata
authors.affiliation: Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.
authors.forename: Tadateru
authors.initials: T
authors.lastname: Takayama
authors.affiliation: Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Hirayama
authors.affiliation: Department of Cardiology, Tokyo Medical University, Tokyo, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Ogawa
authors.affiliation: Department of Cardiology, Tokyo Medical University, Tokyo, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Yamashina
authors.affiliation: Second Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan.
authors.forename: Hisaaki
authors.initials: H
authors.lastname: Mera
authors.affiliation: Second Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Yoshino
authors.affiliation: Third Department of Internal Medicine, Teikyo University Chiba Medical Center, Chiba, Japan.
authors.forename: Fumitaka
authors.initials: F
authors.lastname: Nakamura
authors.affiliation: Cardiovascular Center, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan.
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Seino
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood* / Q000000981:diagnostic imaging* / Q000628:therapy; D000368:Aged; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D052279:Creatine Kinase, MB Form / Q000097:blood; D003661:Decision Support Techniques; D042241:Early Diagnosis; D004630:Emergencies; D000074026:Fatty Acid Binding Protein 3; D050556:Fatty Acid-Binding Proteins / Q000097:blood; D005260:Female; D006801:Humans; D008297:Male; D062645:Percutaneous Coronary Intervention; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D014041:Tokyo; D020107:Troponin T / Q000097:blood*; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; C493408:FABP3 protein, human; D000074026:Fatty Acid Binding Protein 3; D050556:Fatty Acid-Binding Proteins; D020107:Troponin T; D052279:Creatine Kinase, MB Form
keywords: Acute coronary syndrome; Coronary angiography; Culprit lesion; Heart-type fatty acid-binding protein; High-sensitivity troponin T